NPIMap

Individual provider Active NPI

Pratik Rohit Shukla, DO

  • Neuroradiology Physician
  • Bethlehem, PA
National Provider Identifier
1417902768
Registry record updated Feb 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neuroradiology PhysicianTaxonomy code 2085N0700X
License
OS010600L Issued in PA
Practice address
425 Brighton St
#303
Bethlehem, PA 18015-1273
Phone
(610) 868-1100
Fax
(610) 868-1111
NPI assigned
May 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neuroradiology Physician 2085N0700X OS010600L PA Primary

Addresses

Primary practice location

425 Brighton St
#303
Bethlehem, PA 18015-1273

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
01910225MedicaidPA

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
I20031120000543 PA Practitioner - Diagnostic Radiology 3577467729 Reassigns benefits to 1 organization
I20140725001824 NJ Practitioner - Diagnostic Radiology 3577467729 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 1997
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

801 Ostrm St
Bethlehem, PA 18015-1000
Phone (610) 868-1100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.13 of 100Reported as apm
Quality
82.27
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS010600LPAMDNeuroradiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Progressive Physician Assoc Inc CurrentSince Sep 1, 2007 Accepting new patients
Progressive Physician Assoc, Inc. Neuroradiology CurrentSince Sep 1, 2007 Accepting new patients
Progressive Physician Associates, Inc. Neuroradiology Past Accepting new patients
Temple University of the Commonwealth System of Higher Education Past Accepting new patients

Locations

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 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.

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": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518134400000",
    "number": "1417902768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 HIGHLAND AVE",
            "address_2": "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": "425 BRIGHTON ST",
            "address_2": "#303",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180151273",
            "telephone_number": "610-868-1100",
            "fax_number": "610-868-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUKLA",
        "first_name": "PRATIK",
        "middle_name": "ROHIT",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-24",
        "last_updated": "2018-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "PA",
            "license": "OS010600L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01910225",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethlehem, PA

Sources for this page

Verify at the official NPI Registry.