NPIMap

Individual provider Active NPI

Pallav N Shah, MD

  • Diagnostic Radiology Physician
  • Bethlehem, PA
National Provider Identifier
1386633212
Registry record updated Jan 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
25MA07668100 Issued in NJ
Practice address
801 Ostrum St
Bethlehem, PA 18015-1000
Phone
(610) 868-1100
Fax
(610) 868-1111
NPI assigned
Oct 13, 2005
Last updated
Jan 4, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2019

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Neuroradiology Physician 2085N0700X 25MA07668100 NJ
Neuroradiology Physician 2085N0700X MD422836 PA
Diagnostic Radiology Physician 2085R0202X 25MA07668100 NJ Primary
Diagnostic Radiology Physician 2085R0202X MD422836 PA

Addresses

Primary practice location

801 Ostrum St
Bethlehem, PA 18015-1000

Mailing address

95 Highland Ave Ste 130
Bethlehem, PA 18017-9483
Phone (610) 868-1100

Other identifiers 3

IdentifierTypeStateIssuer
101097230MedicaidPA
P00432847OtherPARRMC
0034894MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040713000373 PA Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 7012995327 Reassigns benefits to 1 organization
I20040827000150 NJ Practitioner - Diagnostic Radiology 7012995327 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
State University of Ny Upstate Medical University, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Progressive Physician Assoc IncGroup PAC ID 1355243809, 164 clinicians

Practice addresses (Care Compare)

185 Roseberry St
Phillipsburg, NJ 08865-1690
Phone (908) 859-6700

95 Highland Ave
Suite 130
Bethlehem, PA 18017-9483
Phone (610) 868-1100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA07668100NJMDNeuroradiology Physician
MD422836PAMDNeuroradiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cooper University Radiology, PC Neuroradiology CurrentSince Jan 22, 2018 Accepting new patients
Progressive Physician Assoc Inc Diagnostic Radiology CurrentSince Aug 1, 2018 Accepting new patients
Diagnostic Imaging Inc Diagnostic Radiology Past Accepting new patients
Trustees of the University of Pennsylvania Past Accepting new patients
Progressive Physician Assoc, Inc. Neuroradiology PastSince Aug 1, 2018 Accepting new patients
MRI Physician Associates, PC Diagnostic Radiology Past Accepting new patients
South Jersey Radiology Associates P a Diagnostic Radiology PastSince Mar 6, 1997 Accepting new patients
Univ of Penn Community Radiology Neuroradiology Past Accepting new patients
Diagnostic Imaging of South Jersey PC Diagnostic Radiology Past Accepting new patients

Locations

1 Cooper Plz
Camden, NJ 08103
Phone (856) 342-2425

1 Federal St
Ste SW200
Camden, NJ 08103
Phone (856) 356-4920

2 Cooper Plz
Camden, NJ 08103
Phone (609) 342-7600

185 Roseberry St
Phillipsburg, NJ 08865
Phone (908) 213-6611

95 Highland Ave
Ste 130
Bethlehem, PA 18017
Phone 61086811002

801 Ostrum St
Fountain Hill, PA 18015
Phone (610) 954-2200

Organizations & group practices 9

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 10

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": "1129161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546560000000",
    "number": "1386633212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 HIGHLAND AVE STE 130",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180179483",
            "telephone_number": "610-868-1100",
            "fax_number": "610-868-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 OSTRUM ST",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180151000",
            "telephone_number": "610-868-1100",
            "fax_number": "610-868-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "PALLAV",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-13",
        "last_updated": "2019-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "NJ",
            "license": "25MA07668100",
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "PA",
            "license": "MD422836",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NJ",
            "license": "25MA07668100",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "PA",
            "license": "MD422836",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101097230",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMC",
            "identifier": "P00432847",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0034894",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethlehem, PA

Sources for this page

Verify at the official NPI Registry.