Individual provider Active NPI

Jackson Shaji, D.O.

  • Nephrology Physician
  • Yonkers, NY
National Provider Identifier
1477787315
Registry record updated Dec 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
273982 Issued in NY
Practice address
970 N Broadway
Ste 207
Yonkers, NY 10701-1310
Phone
(914) 969-3635
NPI assigned
May 6, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 273982 NY Primary

Addresses

Primary practice location

970 N Broadway
Ste 207
Yonkers, NY 10701-1310

Mailing address

970 N Broadway
Ste 207
Yonkers, NY 10701-1310
Phone (914) 969-3635

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20141022001927 NY Practitioner - HospitalistPractitioner - Internal MedicinePractitioner - Nephrology 9133345531 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
New York College of Osteo Medicine of New York Institute of Technology, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

259 1St St
Mineola, NY 11501-3957
Phone (516) 663-8963

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.8 of 100Reported as group
Quality
91.79
Promoting interoperability
100
Improvement activities
40
Cost
75.18

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince May 1, 2023 Accepting new patients
New York University CurrentSince May 1, 2023 Accepting new patients
NYU Langone Hospitals Past Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

259 1st St
Rm 291
Mineola, NY 11501
Phone (516) 663-8693

13303 Jamaica Ave
#13292
Richmond Hill, NY 11418
Phone (718) 291-3276

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

14 Wall St
Fl 9
Wall Street, NY 10005
Phone (646) 501-3224

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989

Interoperability endpoints

  • Direct secure messaging: jshaji552560@nyumc.direct-ci.com

Organizations & group practices 3

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 7

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": "1241568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576454400000",
    "number": "1477787315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "970 N BROADWAY",
            "address_2": "STE 207",
            "city": "YONKERS",
            "state": "NY",
            "postal_code": "107011310",
            "telephone_number": "914-969-3635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "970 N BROADWAY",
            "address_2": "STE 207",
            "city": "YONKERS",
            "state": "NY",
            "postal_code": "107011310",
            "telephone_number": "914-969-3635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAJI",
        "first_name": "JACKSON",
        "name_prefix": "Mr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-06",
        "last_updated": "2019-12-16",
        "certification_date": "2019-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NY",
            "license": "273982",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yonkers, NY

Sources for this page

Verify at the official NPI Registry.