Individual provider Active NPI

Pratik Bharat Shah, MD

  • Nephrology Physician
  • Mather, CA
National Provider Identifier
1386964096
Registry record updated Jan 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A164944 Issued in CA
Practice address
10535 Hospital Way
Mather, CA 95655-4200
Phone
(916) 843-2743
NPI assigned
Jun 3, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036.143009 IL
Internal Medicine Physician 207R00000X A164944 CA
Nephrology Physician 207RN0300X 036.143009 IL
Nephrology Physician 207RN0300X A164944 CA Primary

Addresses

Primary practice location

10535 Hospital Way
Mather, CA 95655-4200

Mailing address

326 I St
Davis, CA 95616-4215
Phone (201) 650-6377

Other practice location 1

5841 S Maryland Ave # Mc5100
Chicago, IL 60637-1447
Phone (773) 702-1041

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210805001711 CA Practitioner - NephrologyPractitioner - Internal Medicine 8325272693 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A164944CAMDInternal Medicine Physician
036.143009ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the Univ of Ca CurrentSince Aug 1, 2021 Accepting new patients
Regents of the University of Ca Internal Medicine CurrentSince Aug 1, 2021 Accepting new patients
Regents of the Univ of Ca Current Accepting new patients
Regents of the Univ of Ca Past Accepting new patients
Regents of the Univ of Ca Past Accepting new patients
Dignity Health Past Accepting new patients
The University of Chicago Medical Centers Past Accepting new patients

Locations

4860 Y St
Sacramento, CA 95817
Phone (916) 734-2700

4900 Broadway
Ste 2800
Sacramento, CA 95820
Phone (916) 734-9313

2221 Stockton Blvd
Ste B
Sacramento, CA 95817
Phone (916) 734-2111

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1275523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579737600000",
    "number": "1386964096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "326 I ST",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956164215",
            "telephone_number": "201-650-6377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10535 HOSPITAL WAY",
            "city": "MATHER",
            "state": "CA",
            "postal_code": "956554200",
            "telephone_number": "916-843-2743"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5841 S Maryland Ave # Mc5100",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606371447",
            "country_code": "US",
            "telephone_number": "773-702-1041",
            "fax_number": "773-702-5818",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAH",
        "first_name": "PRATIK",
        "middle_name": "BHARAT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-03",
        "last_updated": "2020-01-23",
        "certification_date": "2020-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036.143009",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A164944",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IL",
            "license": "036.143009",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A164944",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mather, CA

Sources for this page

Verify at the official NPI Registry.