Individual provider Active NPI

Rutu Digantkumar Shah, MD

  • Pediatrics Physician
  • Capitola, CA
National Provider Identifier
1407422975
Registry record updated Mar 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A197007 Issued in CA
Practice address
1820 41St Ave Ste D
Capitola, CA 95010-2516
Phone
(831) 476-3000
Fax
(831) 476-9009
NPI assigned
Jun 3, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A197007 CA Primary

Addresses

Primary practice location

1820 41St Ave Ste D
Capitola, CA 95010-2516

Mailing address

3400 Data Dr
Rancho Cordova, CA 95670-7956

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
I20250320002899 CA Practitioner - Pediatric Medicine 1557883386 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A197007CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dignity Health Medical Foundation Current Accepting new patients
Dignity Health Medical Foundation CurrentSince Jan 6, 2025 Accepting new patients
Dignity Health Medical Foundation CurrentSince Jan 6, 2025 Accepting new patients
Dignity Health Medical Foundation Past Accepting new patients

Locations

1820 41st Ave
Ste D
Capitola, CA 95010
Phone (831) 476-3000

3400 Data Dr
Rncho Cordova, CA 95670
Phone (916) 379-2726

1595 Soquel Dr
Ste 400
Santa Cruz, CA 95065
Phone (831) 475-1111

Interoperability endpoints

  • Direct secure messaging: rutu.shah.1@18107.direct.athenahealth.com

Organizations & group practices 4

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": "1622678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741651200000",
    "number": "1407422975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 DATA DR",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956707956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1820 41ST AVE STE D",
            "city": "CAPITOLA",
            "state": "CA",
            "postal_code": "950102516",
            "telephone_number": "831-476-3000",
            "fax_number": "831-476-9009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "RUTU",
        "middle_name": "DIGANTKUMAR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-03",
        "last_updated": "2025-03-11",
        "certification_date": "2025-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A197007",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Capitola, CA

Sources for this page

Verify at the official NPI Registry.