Surendra J Shah, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

01032180 Issued in IN

Practice address

5825 Broadway
Suite a
Merrillville, IN 46410-2687

Phone

(219) 884-1400

Fax

(219) 884-1453

NPI assigned

Jul 20, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Edgewater Systems for Balanced Living, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Gary, IN
  • NPI 1588705784
  Medicare reassignment NPD
• The Methodist Hospitals, Inc

  • Internal Medicine Physician
  • Gary, IN
  • NPI 1720290349
  Medicare reassignment NPD
• Edgewater Systems for Balanced Living, Inc

  • Federally Qualified Health Center (FQHC)
  • Gary, IN
  • NPI 1093670648
  NPD
• The Methodist Hospitals, Inc

  • Neurology Physician
  • Gary, IN
  • NPI 1720290588
  NPD

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607644800000",
    "number": "1528088689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5825 BROADWAY STE A",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464102664",
            "telephone_number": "219-884-1400",
            "fax_number": "219-884-1453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5825 BROADWAY",
            "address_2": "SUITE A",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464102687",
            "telephone_number": "219-884-1400",
            "fax_number": "219-884-1453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "SURENDRA",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01032180",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100169840A",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sshah7537@themethodisthospitals.direct-ci.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "5825 Broadway Suite A Merrillville, IN 46410",
            "address_1": "5825 Broadway Ste A",
            "city": "Merrillville",
            "state": "IN",
            "country_code": "US",
            "postal_code": "464102664",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sshah7537@themethodisthospitals.direct-ci.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "5825 Broadway Suite A Merrillville, IN 46410",
            "address_1": "5825 Broadway Ste A",
            "city": "Merrillville",
            "state": "IN",
            "country_code": "US",
            "postal_code": "464102664",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Aaditya Vijay Shah, MD
• Harish A Shah, MD
• Mahendra M Shah, MD
• Rupesh J. Shah
• Sheralee Pradeep Shah, DPT
• Tarek H Shahbandar, M.D.
• Ammar M Shaheen, MD
• Manpreet Kaur Shahi, O.D.
• Kaniah R Shamsid-Deen
• Shannon McCarthy MD Inc

• Internal Medicine Physician in Merrillville, IN
• Providers in Merrillville, IN by specialty
• Internal Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.