NPIMap

Individual provider Active NPI

Jay Shah, M.D.

  • Family Medicine Physician
  • Hartford, MI
National Provider Identifier
1487974663
Registry record updated Aug 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301103258 Issued in MI
Practice address
525 S Center St
Hartford, MI 49057-1362
Phone
(269) 463-3600
Fax
(269) 621-9972
NPI assigned
Jun 10, 2010
Last updated
Aug 6, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036133075 IL
Family Medicine Physician 207Q00000X 4301103258 MI Primary

Addresses

Primary practice location

525 S Center St
Hartford, MI 49057-1362

Mailing address

525 S Center St
Hartford, MI 49057-1362
Phone (269) 463-3600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131104001500 MI Practitioner - Family Practice 1658506373 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lakeland Medical PracticesGroup PAC ID 1658427042, 286 clinicians

Practice addresses (Care Compare)

4077 S Cleveland Ave
Saint Joseph, MI 49085-9513
Phone (269) 429-2992

525 S Ctr St
Hartford, MI 49057-1362
Phone (269) 463-3600

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036133075ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeland Community Hospital Watervliet Family Medicine CurrentSince Jul 1, 2013 Accepting new patients
Lakeland Community Hospital Watervliet CurrentSince Jul 1, 2013 Accepting new patients
Lakeland Medical Practices CurrentSince Jun 25, 2018 Accepting new patients
Lakeland Medical Practices CurrentSince Jun 25, 2018 Accepting new patients
Lakeland Community Hospital Watervliet Family Medicine Past Accepting new patients

Locations

525 S Center St
Hartford, MI 49057
Phone (269) 621-4063

3950 Hollywood Rd
Ste 270
Saint Joseph, MI 49085
Phone (269) 982-7840

3950 Hollywood Rd
Ste 280
Saint Joseph, MI 49085
Phone (269) 408-0990

4077 S Cleveland Ave
Saint Joseph, MI 49085
Phone (269) 429-2992

400 Medical Park Dr
Watervliet, MI 49098
Phone (269) 463-3111

Interoperability endpoints

  • FHIR API: https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/R4/
  • Direct secure messaging: jshah1271903@epic00.corewelldirect.org
  • Direct secure messaging: jshah16654@lakeland.midirect.net

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Corewell Health Watervliet Hospital Primary CareWatervliet, MI, CCN 238605 Rural health clinic Other Jan 1, 2020
Corewell Health Watervliet Hospital Primary Care - ColomaColoma, MI, CCN 238603 Rural health clinic Other Jan 1, 2020
Corewell Health Watervliet Hospital Primary Care - HartfordHartford, MI, CCN 238604 Rural health clinic Other Jan 1, 2020
Corewell Health Watervliet Hospital Southwestern Medical MultispecialtNiles, MI, CCN 238664 Rural health clinic Other Jan 1, 2020

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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 4

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": "1276128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375747200000",
    "number": "1487974663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 S CENTER ST",
            "city": "HARTFORD",
            "state": "MI",
            "postal_code": "490571362",
            "telephone_number": "269-463-3600",
            "fax_number": "269-621-9972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 S CENTER ST",
            "city": "HARTFORD",
            "state": "MI",
            "postal_code": "490571362",
            "telephone_number": "269-463-3600",
            "fax_number": "269-621-9972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "JAY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-10",
        "last_updated": "2013-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036133075",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301103258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartford, MI

Sources for this page

Verify at the official NPI Registry.