Individual provider Active NPI

Andrita Shah, D.O

  • Family Medicine Physician
  • Detroit, MI
National Provider Identifier
1477972198
Registry record updated Jan 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
H84394 Issued in MD
Practice address
3031 W Grand Blvd Ste 450
Detroit, MI 48202-3026
Phone
(313) 871-3751
NPI assigned
Apr 9, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X H84394 MD Primary

Addresses

Primary practice location

3031 W Grand Blvd Ste 450
Detroit, MI 48202-3026

Mailing address

5801 Allentown Rd Ste 202
Camp Springs, MD 20746-4562

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20190826000791 VA Practitioner - Family Practice 9537428362 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sentara Medical GroupGroup PAC ID 8921903923, 1,396 clinicians

Practice addresses (Care Compare)

12825 Minnieville Rd
Suite 202
Lake Ridge, VA 22192-3602
Phone (703) 523-9870

Hospital & facility affiliations

  • Sentara Home Care Services Home health agency, Dumfries, VA, CCN 497675
  • Sentara Northern Virginia Medical Center Hospital, Woodbridge, VA, CCN 490113

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sentara Medical Group Family Medicine CurrentSince Aug 5, 2019 Accepting new patients
Detroit Wayne County Health Authority PastSince Jul 6, 2020 Accepting new patients
Partners in Wellness Family Medicine Past Accepting new patients

Locations

850 Kempsville Rd
Norfolk, VA 23502
Phone (757) 261-0162

12825 Minnieville Rd
Ste 202
Woodbridge, VA 22192
Phone (703) 523-9870

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/19827/brand/1/csg/1/fhir/r4
  • Direct secure messaging: ashah516233@direct.sentara.net

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 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": "1397001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1514851200000",
    "number": "1477972198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5801 ALLENTOWN RD STE 202",
            "city": "CAMP SPRINGS",
            "state": "MD",
            "postal_code": "207464562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3031 W GRAND BLVD STE 450",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023026",
            "telephone_number": "313-871-3751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "ANDRITA",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-09",
        "last_updated": "2018-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "H84394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.