NPIMap

Individual provider Active NPI

Bushra Shah, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Little Rock, AR
National Provider Identifier
1417910670
Registry record updated Dec 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
E-3672 Issued in AR
Practice address
1 Saint Vincent Cir
Suite 210
Little Rock, AR 72205-5405
Phone
(501) 552-4777
Fax
(501) 552-4570
NPI assigned
Apr 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X E-3672 AR Primary

Addresses

Primary practice location

1 Saint Vincent Cir
Suite 210
Little Rock, AR 72205-5405

Mailing address

1 Saint Vincent Cir
Suite 210
Little Rock, AR 72205-5405
Phone (501) 552-4777

Other identifiers 3

IdentifierTypeStateIssuer
155015001MedicaidAR
4070011000OtherARQUALCHOICE
P00185272OtherARMEDICARE RAILROAD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040615001861 AR Practitioner - Geriatric MedicinePractitioner - Family Practice 3476537606 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Geriatric Medicine
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

100 Vigne Dr
Little Rock, AR 72223-4581
Phone (501) 552-4777

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Bushra Shah MD PLLC Geriatric Medicine CurrentSince Apr 2, 2017 Accepting new patients

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Briarwood Nursing & Rehabilitation CenterLittle Rock, AR, CCN 045387 Skilled nursing facility Adp of the SNF Dec 10, 2024
Hickory Heights Health and Rehab LLCLittle Rock, AR, CCN 045455 Skilled nursing facility Adp of the SNF Dec 10, 2024
Colonel Glenn Health and Rehab LLCLittle Rock, AR, CCN 045460 Skilled nursing facility Adp of the SNF Dec 10, 2024

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 1

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 6

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": "1144627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450656000000",
    "number": "1417910670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SAINT VINCENT CIR",
            "address_2": "SUITE 210",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055405",
            "telephone_number": "501-552-4777",
            "fax_number": "501-552-4448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SAINT VINCENT CIR",
            "address_2": "SUITE 210",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055405",
            "telephone_number": "501-552-4777",
            "fax_number": "501-552-4570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "BUSHRA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-10",
        "last_updated": "2015-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "AR",
            "license": "E-3672",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "155015001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUALCHOICE",
            "identifier": "4070011000",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00185272",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.