NPIMap

Organization Active NPI

Bharat J Shah MD Inc

  • Geriatric Psychiatry Physician
  • Fairlawn, OH
National Provider Identifier
1396825675
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Psychiatry PhysicianTaxonomy code 2084P0805X
License
35051270 Issued in OH
Legal business name
BHARAT J SHAH MD INC
Practice address
63 Baker Blvd
Fairlawn, OH 44333-3601
Phone
(330) 572-0641
Fax
(330) 572-0639
NPI assigned
Oct 17, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Bharat J Shah, M.D.NPI 1891771630
Title
President
Phone
(330) 572-0641

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Psychiatry Physician 2084P0805X 35051270 OH Primary

Addresses

Primary practice location

63 Baker Blvd
Fairlawn, OH 44333-3601

Mailing address

63 Baker Blvd
Fairlawn, OH 44333-3601
Phone (330) 572-0641

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040120000738 OH Part B Supplier - Clinic/Group Practice 5890696926 Receives reassigned benefits from 7 practitioners
Practice locations: Fairlawn, OH

National Provider Directory

National Provider Directory

Locations

63 Baker Blvd
Fairlawn, OH 44333
Phone (330) 572-0645

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1396825675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 BAKER BLVD",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "443333601",
            "telephone_number": "330-572-0641",
            "fax_number": "330-572-0639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63 BAKER BLVD",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "443333601",
            "telephone_number": "330-572-0641",
            "fax_number": "330-572-0639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BHARAT J SHAH MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "BHARAT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "330-572-0641",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "OH",
            "license": "35051270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairlawn, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.