NPIMap

Individual provider Active NPI

Shambo Guha Roy, MD

  • Student in an Organized Health Care Education/Training Program
  • Darby, PA
National Provider Identifier
1376029926
Registry record updated Jul 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
MT216697 Issued in PA
Practice address
1500 Lansdowne Ave
Darby, PA 19023-1200
Phone
(610) 237-4000
NPI assigned
Jul 17, 2018
Last updated
Jul 17, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X MT216697 PA Primary

Addresses

Primary practice location

1500 Lansdowne Ave
Darby, PA 19023-1200

Mailing address

1500 Lansdowne Ave
Darby, PA 19023-1200
Phone (610) 237-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240712003089 NC Practitioner - Diagnostic Radiology 8921543026 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wake Forest Health Network LLCGroup PAC ID 4183538895, 276 clinicians
Wake Forest Baptist Imaging LLCGroup PAC ID 3173681681, 76 clinicians

Practice addresses (Care Compare)

1814 Westchester Dr
Suite 100
High Point, NC 27262-7369
Phone (336) 802-2175

265 Executive Park Blvd
Winston Salem, NC 27103-1503
Phone (336) 765-5722

Medical Ctr Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2734

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MT216697PAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest University Health Sciences CurrentSince Jul 1, 2024 Accepting new patients
Wake Forest Health Network, LLC CurrentSince Jun 1, 2025 Accepting new patients
Wake Forest Health Network LLC CurrentSince Jun 1, 2025 Accepting new patients
Wake Forest Health Network LLC Current Accepting new patients
Wake Forest Baptist Imaging, LLC CurrentSince Apr 18, 2024 Accepting new patients
Wake Forest Baptist Imaging, LLC CurrentSince Apr 18, 2024 Accepting new patients

Locations

223 W Ward St
#B
Asheboro, NC 27203

223 W Ward St
Ste B
Asheboro, NC 27203
Phone (336) 702-1731

1814 Westchester Dr
Ste 100
High Point, NC 27262
Phone (336) 802-2397

905 Phillips Ave
High Point, NC 27262
Phone (336) 802-2040

861 Old Winston Rd
Ste 105
Kernersville, NC 27284
Phone (336) 765-5722

100 Kimel Forest Dr
Winston Salem, NC 27103
Phone (336) 713-0947

265 Executive Park Blvd
Winston Salem, NC 27103
Phone (336) 765-5722

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

Interoperability endpoints

  • Direct secure messaging: sguharoy2016085@direct.trinity-health.org
  • Direct secure messaging: sguharoy2939084@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1531785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531785600000",
    "number": "1376029926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 LANSDOWNE AVE",
            "city": "DARBY",
            "state": "PA",
            "postal_code": "190231200",
            "telephone_number": "610-237-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 LANSDOWNE AVE",
            "city": "DARBY",
            "state": "PA",
            "postal_code": "190231200",
            "telephone_number": "610-237-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUHA ROY",
        "first_name": "SHAMBO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-17",
        "last_updated": "2018-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": "MT216697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Darby, PA

Sources for this page

Verify at the official NPI Registry.