Individual provider Active NPI

Kevin Atul Shah

  • Neurological Surgery Physician
  • Winston Salem, NC
National Provider Identifier
1467816983
Registry record updated Nov 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
2025-03776 Issued in NC
Practice address
190 Kimel Park Dr Ste 155
Winston Salem, NC 27103-6946
Phone
(336) 765-6637
Fax
(336) 765-6964
NPI assigned
Apr 11, 2016
Last updated
Nov 26, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Neurological Surgery Physician 207T00000X 2025-03776 NC Primary
Neurological Surgery Physician 207T00000X PENDING NY

Addresses

Primary practice location

190 Kimel Park Dr Ste 155
Winston Salem, NC 27103-6946

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other practice location 1

270 E Main St
Bay Shore, NY 11706-8420
Phone (631) 591-7470

Other names 1

  • Kevin Shah Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20230731001863 NY Practitioner - Neurosurgery 6406190701 Reassigns benefits to 2 organizations
I20251215002478 NC Practitioner - Neurosurgery 6406190701 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Florida International Univ, College of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

1983 Marcus Ave
New Hyde Park, NY 11042-2000
Phone (718) 470-3440

330 Billingsley Rd
Suite 202
Charlotte, NC 28211-5020
Phone (704) 316-2350

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Laminectomy or laminotomy (partial removal of spine bones)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PENDINGNYMDHematology & Oncology Physician
2025-03776NCMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore Health System Medical Faculty Group Practice Inc CurrentSince Dec 19, 2024 Accepting new patients
North Shore-Lij Medical PC Neurological Surgery CurrentSince Aug 1, 2023 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Nov 1, 2025 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Nov 1, 2025 Accepting new patients
North Shore - Lij Medical PC CurrentSince Aug 1, 2023 Accepting new patients
Novant Medical Group, Inc. Past Accepting new patients
South Shore University Hospital Past Accepting new patients

Locations

330 Billingsley Rd
Ste 202
Charlotte, NC 28211
Phone (704) 316-2350

190 Kimel Park Dr
Ste 155
Winston Salem, NC 27103
Phone (336) 765-6637

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

270 E Main St
Bay Shore, NY 11706
Phone (631) 591-7470

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

300 Community Dr
Manhasset, NY 11030

1111 Marcus Ave
Ste M04
New Hyde Park, NY 11042
Phone (585) 736-3650

1983 Marcus Ave
New Hyde Park, NY 11042
Phone (516) 326-5600

450 Lakeville Rd
North New Hyde Park, NY 11042
Phone (516) 321-3000

Interoperability endpoints

  • Direct secure messaging: kshah1751081@direct.novanthealth.org

Organizations & group practices 8

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.

Hospital & facility affiliations 2

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": "1460332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764115200000",
    "number": "1467816983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 KIMEL PARK DR STE 155",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036946",
            "telephone_number": "336-765-6637",
            "fax_number": "336-765-6964"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "270 E Main St",
            "address_purpose": "LOCATION",
            "city": "Bay Shore",
            "state": "NY",
            "postal_code": "117068420",
            "country_code": "US",
            "telephone_number": "631-591-7470",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAH",
        "first_name": "KEVIN",
        "middle_name": "ATUL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-11",
        "last_updated": "2025-11-26",
        "certification_date": "2025-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "NC",
            "license": "2025-03776",
            "primary": true
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "NY",
            "license": "PENDING",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KEVIN",
            "last_name": "SHAH",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.