Individual provider Active NPI

Nishant Shah

  • Family Medicine Physician
  • Baltimore, MD
National Provider Identifier
1497940159
Registry record updated Dec 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
D79853 Issued in MD
Practice address
330 N Howard St
Baltimore, MD 21201-3610
Phone
(410) 576-1414
Fax
(410) 385-2762
NPI assigned
Sep 6, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 2, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Family Medicine) Physician 207QA0401X D79853 MD
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X D79853 MD Primary

Addresses

Primary practice location

330 N Howard St
Baltimore, MD 21201-3610

Mailing address

19 S Collington Ave
Baltimore, MD 21231-2013
Phone (925) 863-9621

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20200416000909 MD Practitioner - Family Practice 5294905428 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D79853MDMDAddiction Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Johns Hopkins Community Physicians CurrentSince Apr 1, 2020 Accepting new patients
Johns Hopkins Community Physicians, Inc Single Specialty Current Accepting new patients
Johns Hopkins Community Physicians, Inc Single Specialty CurrentSince Apr 1, 2020 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Planned Parenthood of Maryland, Inc. Single Specialty Past Accepting new patients

Locations

1000 E Eager St
Baltimore, MD 21202
Phone (410) 522-9800

9910 Franklin Square Dr
#2110
Nottingham, MD 21236
Phone (410) 933-5412

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 and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701475200000",
    "number": "1497940159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 S COLLINGTON AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212312013",
            "telephone_number": "925-863-9621",
            "fax_number": "347-763-8386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 N HOWARD ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212013610",
            "telephone_number": "410-576-1414",
            "fax_number": "410-385-2762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "NISHANT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-06",
        "last_updated": "2023-12-02",
        "certification_date": "2023-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "MD",
            "license": "D79853",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D79853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.