Samir K Shah, M.D.

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

036-063403 Issued in IL

Practice address

6810 State Route 162 Ste 102
Maryville, IL 62062-8560

Phone

(618) 288-4076

Fax

(618) 288-4215

NPI assigned

Jul 27, 2006

Last updated

Nov 25, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/6901/brand/1/csg/1/fhir/r4
• FHIR API: https://fhirprd.edward.org/fhirprd/api/FHIR/R4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Edward Hospital

  • General Acute Care Hospital
  • Naperville, IL
  • NPI 1013969013
  Medicare reassignment NPD
• Elmhurst Memorial Hospital

  dba Endeavor Health Elmhurst Hospital

  • General Acute Care Hospital
  • Elmhurst, IL
  • NPI 1548306343
  Medicare reassignment NPD
• Lumen Cardiovascular Specialists,LTD

  • Cardiovascular Disease Physician
  • Elmhurst, IL
  • NPI 1821432329
  Medicare reassignment NPD
• Naperville Psychiatric Ventures

  dba Linden Oaks Hospital

  • Psychiatric Hospital
  • Naperville, IL
  • NPI 1871628362
  Medicare reassignment NPD
• Rockford Health Physicians

  dba Mercyhealth Physicians

  • Multi-Specialty Clinic/Center
  • Rockford, IL
  • NPI 1043242886
  Medicare reassignment NPD
• Fairview Heights Medical Group SC

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1679503668

  IL

  Medicare reassignment NPD
• Edward Hospital

  • Home Health Agency
  • Naperville, IL
  • NPI 1912930645

  Cardiovascular Disease

  NPD
• Naperville Psychiatric Ventures

  dba Endeavor Health Linden Oaks Hospital

  • Psychiatric Hospital
  • Naperville, IL
  • NPI 1619910460
  NPD
• Fairview Heights Medical Group SC

  dba BJC Medical Group of Illinois

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1073022000
  NPD
• PMR Illinois Holding, LLC

  • Specialist
  • Miami Gardens, FL
  • NPI 1770038671
  NPD
• Advocate Health Centers, Inc.

  • Multi-Specialty Clinic/Center
  • Chicago, IL
  • NPI 1639111933
  NPD (past)
• High Technology, Inc.

  dba High Tech Medical Park

  • Radiation Oncology Clinic/Center
  • Palos Heights, IL
  • NPI 1053484667
  NPD (past)

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764028800000",
    "number": "1427072768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 959203",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631959203",
            "telephone_number": "618-288-4076",
            "fax_number": "618-288-4215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6810 STATE ROUTE 162 STE 102",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620628560",
            "telephone_number": "618-288-4076",
            "fax_number": "618-288-4215"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2350 N Rockton Ave",
            "address_purpose": "LOCATION",
            "city": "Rockford",
            "state": "IL",
            "postal_code": "611033600",
            "country_code": "US",
            "telephone_number": "815-971-2200",
            "fax_number": "815-971-9097",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4600 Memorial Dr Ste 300",
            "address_purpose": "LOCATION",
            "city": "Belleville",
            "state": "IL",
            "postal_code": "622265363",
            "country_code": "US",
            "telephone_number": "618-233-3066",
            "fax_number": "314-996-7658",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAH",
        "first_name": "SAMIR",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2025-11-25",
        "certification_date": "2025-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RA0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Adolescent Medicine",
            "state": "IL",
            "license": "036-063403",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036-063403",
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "IL",
            "license": "036-063403",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "01636052",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036063403",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "6810 State Route 162 Ste 102",
            "city": "Maryville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "620628560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4600 Memorial Dr Ste 300",
            "city": "Belleville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622265363",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Elizabeth Schwenk
• Jonathan Sehy, M.D., PH.D.
• Senior Homecare LLC (Senior Helpers of the Metro East)
• Serenity Surgery
• Charles Miguel Serrano, CRNA
• Jessica Lynn Sheffer, MSN, APRN, FNP-BC
• Kyle Shepperson, MD
• Jodie Shipley, DNP
• Holly Harlow Shirley, N.P.
• McKenna Ivy Shofroth, RN

• Cardiovascular Disease Physician in Maryville, IL
• Providers in Maryville, IL by specialty
• Cardiovascular Disease Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.