Yogendra Ambalal Shah, M.D.,S.C.

Primary specialty

SpecialistTaxonomy code 174400000X

License

036048989 Issued in IL

Practice address

3165 Myrtle Ave
Granite City, IL 62040-5012

Phone

(618) 451-7717

Fax

(618) 451-7780

NPI assigned

Mar 18, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Ozarks Medical Center

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  NPD (past)

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

{
    "created_epoch": "1174176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376667253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3165 MYRTLE AVE",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620405012",
            "telephone_number": "618-451-7717",
            "fax_number": "618-451-7780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3165 MYRTLE AVE",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620405012",
            "telephone_number": "618-451-7717",
            "fax_number": "618-451-7780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "YOGENDRA",
        "middle_name": "AMBALAL",
        "name_prefix": "Dr.",
        "credential": "M.D.,S.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "036048989",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036048989",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashtin Sechrest, LCSW
• Debra K Seiffert, DNP, APRN, PMHNP-BC
• Karen E Sein Ohn, MD
• Katie Serrano, DMD
• Seth Tilzer, Inc
• Ann G Shashack, RPH
• Shipley Chiropractic LTD
• Laura Beth Shipley, D.C.
• Lawrence Allen Shipley II, D.C.
• James Aaron Shultz

• Specialist in Granite City, IL
• Providers in Granite City, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.