Active NPI
Mohan M Shah, MD
- Hospice and Palliative Medicine (Family Medicine) Physician
- Lakeland, FL
National Provider Identifier
1477515302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hospice and Palliative Medicine (Family Medicine) Physician
- License
- ME53099
- Practice address
- 115 S Missouri Ave
Suite 500
Lakeland, FL 33815-4600 - Phone
- (863) 682-0027
- Fax
- (863) 682-3006
- NPI assigned
- Apr 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | ME53099 | FL | |
| Hospice and Palliative Medicine (Family Medicine) Physician | 207QH0002X | ME53099 | FL | Primary |
Addresses
Primary practice location
115 S Missouri Ave
Suite 500
Lakeland, FL 33815-4600
Mailing address
115 S Missouri Ave
Suite 500
Lakeland, FL 33815-4600
Phone (863) 682-0027
Other practice location 1
4450 W Eau Gallie Blvd Ste 250
Melbourne, FL 32934-7215
Phone (877) 868-4827
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | referral@vitas.direct.kno2fy.com | VITAS Solutions Inc |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Hospice/Palliative Care
- Education
- Other, 1981
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Legacy Healthcare Services Inc
Practice addresses (Care Compare)
17470 Brookside Trace CT
Tampa, FL 33647-6201
Phone (813) 443-5042
Hospital & facility affiliations
- Vitas Healthcare Corporation of Florida
Merit-based Incentive Payment System (MIPS)
- Final score
- 95.12 of 100
- Quality
- 85
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME53099 | FL | MD | Family Medicine Physician |
Interoperability endpoints
- mshah71599@epicdirect.hf.org
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.
-
- Hospice and Palliative Medicine (Internal Medicine) Physician
- Miramar, FL
- NPI 1861666497
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Community Based Hospice Care Agency
- Boynton Beach, FL
- NPI 1467507657
-
- Community Based Hospice Care Agency
- Miami Lakes, FL
- NPI 1528113792
-
- Community Based Hospice Care Agency
- Melbourne, FL
- NPI 1669548053
-
- Community Based Hospice Care Agency
- Tallahassee, FL
- NPI 1972555464
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617062400000",
"number": "1477515302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 S MISSOURI AVE",
"address_2": "SUITE 500",
"city": "LAKELAND",
"state": "FL",
"postal_code": "338154600",
"telephone_number": "863-682-0027",
"fax_number": "863-682-3006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 S MISSOURI AVE",
"address_2": "SUITE 500",
"city": "LAKELAND",
"state": "FL",
"postal_code": "338154600",
"telephone_number": "863-682-0027",
"fax_number": "863-682-3006"
}
],
"practiceLocations": [
{
"address_1": "4450 W Eau Gallie Blvd Ste 250",
"address_purpose": "LOCATION",
"city": "Melbourne",
"state": "FL",
"postal_code": "329347215",
"country_code": "US",
"telephone_number": "877-868-4827",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SHAH",
"first_name": "MOHAN",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-05",
"last_updated": "2021-03-30",
"certification_date": "2021-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "ME53099",
"primary": false
},
{
"code": "207QH0002X",
"taxonomy_group": "",
"desc": "Family Medicine, Hospice and Palliative Medicine",
"state": "FL",
"license": "ME53099",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "referral@vitas.direct.kno2fy.com",
"affiliation": "Y",
"affiliationName": "VITAS Solutions Inc",
"address_1": "3720 Executive Way",
"city": "Miramar",
"state": "FL",
"country_code": "US",
"postal_code": "330253946",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Lakeland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2021; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.