NPIMap

Individual provider Active NPI

Sairav B Shah, M.D.

  • Interventional Cardiology Physician
  • Gillette, WY
National Provider Identifier
1386614113
Registry record updated Oct 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
9196A Issued in WY
Practice address
501 S Burma Avenue
Ste 3500
Gillette, WY 82716-3426
Phone
(307) 688-3700
Fax
(307) 688-7920
NPI assigned
Jan 24, 2006
Last updated
Oct 14, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 9196A WY
Cardiovascular Disease Physician 207RC0000X 35154 AZ
Interventional Cardiology Physician 207RI0011X 9196A WY Primary

Addresses

Primary practice location

501 S Burma Avenue
Ste 3500
Gillette, WY 82716-3426

Mailing address

PO Box 3011
Gillette, WY 82717-3011
Phone (307) 688-3700

Other identifiers 1

IdentifierTypeStateIssuer
099093MedicaidAZ

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cchwyo@cchwyo.sdhealthlink.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY
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
I20140904000897 WY Practitioner - Cardiovascular Disease (Cardiology) 9537137898 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Indiana University School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Campbell County Hospital DistrictGroup PAC ID 2860392529, 128 clinicians

Practice addresses (Care Compare)

501 S Burma Ave
Gillette, WY 82716-3426
Phone (307) 688-1000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting1-10
Pacemaker insertion or repair1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9196AWYMDInternal Medicine Physician
35154AZMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Campbell County Hospital District Current Accepting new patients
Campbell County Hospital District CurrentSince May 24, 2014 Accepting new patients
Campbell County Hospital District Internal Medicine Current Accepting new patients
Campbell County Hospital District Current Accepting new patients
Campbell County Hospital District CurrentSince May 24, 2014 Accepting new patients
Campbell County Hospital District Past Accepting new patients
Campbell County Hospital District Past Accepting new patients
Flagstaff Medical Center Past Accepting new patients

Locations

501 S Burma Ave
Gillette, WY 82716
Phone (307) 682-8811

501 S Burma Ave
#3700
Gillette, WY 82716

501 S Burma Ave
Fl 3
Gillette, WY 82716
Phone (307) 688-3636

501 S Burma Ave
Ste 3500
Gillette, WY 82716
Phone (307) 688-3500

Organizations & group practices 8

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 6

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": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602633600000",
    "number": "1386614113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3011",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827173011",
            "telephone_number": "307-688-3700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S BURMA AVENUE",
            "address_2": "STE 3500",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827163426",
            "telephone_number": "307-688-3700",
            "fax_number": "307-688-7920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "SAIRAV",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-24",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WY",
            "license": "9196A",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "AZ",
            "license": "35154",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "WY",
            "license": "9196A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "099093",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cchwyo@cchwyo.sdhealthlink.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "501 S Burma Avenue",
            "address_2": "Ste 3500",
            "city": "Gillette",
            "state": "WY",
            "country_code": "US",
            "postal_code": "827163426",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Gillette, WY

Sources for this page

Verify at the official NPI Registry.