Keyurkumar Anilkumar Shah, M.D.
Individual provider Active NPI Surgery Physician · Worthington, MN
NPI 1508919804 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1508919804
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 60575 (MN)
- Practice address
- 1216 Ryans Rd Ste 1
Worthington, MN 56187-1722 - Phone
- (507) 372-2921
- NPI assigned
- Jan 19, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 21
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Orthopedic Surgery
- Education
- Other, 1988
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Avera Marshall
Practice addresses (Care Compare)
300 S Bruce St
Marshall, MN 56258-1934
Phone (507) 532-9661
Hospital & facility affiliations
- Avera Marshall Regional Medical Ctr
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170105000452 | MN | Practitioner - Orthopedic Surgery | 7911989793 | Reassigns benefits to 6 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0059271 | MD | MD | Surgery Physician |
| MD2012-0683 | NM | MD | Surgery Physician |
| 0101239675 | VA | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Avera Tyler | Multi-Specialty | Current |
Accepting new patients |
| Avera Marshall | Current |
Accepting new patients | |
| Avera Tyler | Multi-Specialty | Current | Accepting new patients |
| Avera Marshall | Multi-Specialty | Current | Accepting new patients |
| Avera Granite Falls | Current | Accepting new patients | |
| Avera Tyler | Multi-Specialty | Current |
Accepting new patients |
| Avera Marshall | Current |
Accepting new patients |
Locations
345 10th Ave
Granite Falls, MN 56241
Phone (320) 564-3111
300 S Bruce St
Marshall, MN 56258
Phone (507) 532-9631
Interoperability endpoints
- keyurkumar.shah@avera.sdhealthlink.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | D0059271 | MD | |
| Surgery Physician | 208600000X | 0101239675 | VA | |
| Surgery Physician | 208600000X | MD2012-0683 | NM | |
| Student in an Organized Health Care Education/Training Program | 390200000X | MD2012-0683 | NM | |
| Surgery Physician |
208600000X | 60575 | MN | Yes |
Addresses
Primary practice location
1216 Ryans Rd Ste 1
Worthington, MN 56187-1722
Mailing address
1216 Ryans Road
Worthington, MN 56187
Phone (507) 372-2921
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4043561 00 | Medicaid | MD |
Other providers in Worthington, MN
- Janelle A Saufley
- Peggy Saxton
- Amanda Schmitz
- Jodi Lynn Scott
- Kristine Ranae Shaffer
- Syed Asad Ali Shah
- Meegan Shebeck
- Shopko Stores Operating Co LLC
- Shopko Stores Operating Co. LLC
- Stacy Wahl Slettum
All providers in Worthington, MN · Surgery Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.