NPIMap

Individual provider Active NPI

Syed Ahmed Shah, M.D.

  • Neurology Physician
  • Centralia, IL
National Provider Identifier
1508867300
Registry record updated Sep 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
036097235 Issued in IL
Practice address
1007 ML King Dr
Suite 1
Centralia, IL 62801-3003
Phone
(618) 533-9577
Fax
(618) 533-9588
NPI assigned
Aug 3, 2005
Last updated
Sep 9, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 9, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 036097235 IL Primary

Addresses

Primary practice location

1007 ML King Dr
Suite 1
Centralia, IL 62801-3003

Mailing address

PO Box 431
Centralia, IL 62801-9107
Phone (618) 533-9577

Other practice location 1

1007 S 42nd St Ste 2
Mount Vernon, IL 62864-6217
Phone (618) 241-9587

Other practice location 2

929 Stacey Burk Dr
Flora, IL 62839-3241
Phone (618) 533-9577

Other practice location 3

705 S Grand St
Nashville, IL 62263-1534
Phone (618) 533-9577

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20041022001080 IL Practitioner - NeurologyPractitioner - Interventional Pain Management 3678534500 Reassigns benefits to 2 organizations
Practice locations: Centralia, IL; Mount Vernon, IL; Nashville, IL

Care Compare profile

Medicare Care Compare
Specialty
NeurologyAlso: Interventional Pain Management
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1 Good Samaritan Way
Mount Vernon, IL 62864-2402
Phone (557) 203-1601

1007 M L King Dr
Centralia, IL 62801-3001
Phone (618) 533-9577

1007 S 42ND St
Suite 2
Mount Vernon, IL 62864-6217
Phone (618) 241-9587

400 N Pleasant Ave
Centralia, IL 62801-3056
Phone (618) 436-8000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
24.77 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
82.58

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
92.55
Promoting interoperability
100
Improvement activities
40
Cost
79.49

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036097235ILMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ahuja Bariatric & Beyond Current Accepting new patients
Good Samaritan Regional Health Center CurrentSince Jan 4, 2026 Accepting new patients
Good Samaritan Regional Health Center Neurology CurrentSince Jan 4, 2026 Accepting new patients
St. Mary's Hospital, Centralia, Illinois CurrentSince Jan 1, 2004 Accepting new patients
St. Mary's Hospital, Centralia, Illinois Neurology CurrentSince Jan 1, 2004 Accepting new patients
Illinois Department of Human Past Accepting new patients

Locations

400 N Pleasant Ave
Centralia, IL 62801
Phone (618) 436-5221

7420 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-3155

1 Good Samaritan Way
Mount Vernon, IL 62864
Phone (618) 242-4600

2 Good Samaritan Way
Ste 120
Mount Vernon, IL 62864
Phone (618) 899-4999

5 Good Samaritan Way
Mount Vernon, IL 62864
Phone (557) 203-1601

1145 Corporate Lake Dr
Saint Louis, MO 63132
Phone (314) 989-6189

Interoperability endpoints

  • Direct secure messaging: sshah82050@direct-ehr-ssmhc.com
  • Direct secure messaging: syedshahmd.syedshah@141598.advancedmd-direct.com

Organizations & group practices 6

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 8

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": "1123027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631145600000",
    "number": "1508867300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 431",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628019107",
            "telephone_number": "618-533-9577",
            "fax_number": "618-533-9588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 ML KING DR",
            "address_2": "SUITE 1",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013003",
            "telephone_number": "618-533-9577",
            "fax_number": "618-533-9588"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1007 S 42nd St Ste 2",
            "address_purpose": "LOCATION",
            "city": "Mount Vernon",
            "state": "IL",
            "postal_code": "628646217",
            "country_code": "US",
            "telephone_number": "618-241-9587",
            "fax_number": "618-241-9589",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "929 Stacey Burk Dr",
            "address_purpose": "LOCATION",
            "city": "Flora",
            "state": "IL",
            "postal_code": "628393241",
            "country_code": "US",
            "telephone_number": "618-533-9577",
            "fax_number": "618-533-9588",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "705 S Grand St",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "IL",
            "postal_code": "622631534",
            "country_code": "US",
            "telephone_number": "618-533-9577",
            "fax_number": "618-533-9588",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAH",
        "first_name": "SYED",
        "middle_name": "AHMED",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-03",
        "last_updated": "2021-09-09",
        "certification_date": "2021-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IL",
            "license": "036097235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Centralia, IL

Sources for this page

Verify at the official NPI Registry.