Shan Sivendra, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

25MA06930200 Issued in NJ

Practice address

94 Old Short Hills Rd
Livingston, NJ 07039-5672

Phone

(201) 322-5000

NPI assigned

Sep 16, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ, NY2 enrollments

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 2

Specialty

Internal Medicine

Education

Other, 1989

Medicare assignment

May accept Medicare assignment

Group practices

Back and Body Medical Care, P.C.Group PAC ID 6709911753, 3 clinicians

Back and Body Pain Relief LLCGroup PAC ID 7517204407, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Back and Body Pain Relief LLC

  • Chiropractor
  • Springfield, NJ
  • NPI 1336656461
  Medicare reassignment Care Compare group NPD Authorized official
• Back and Body Medical Care, P.C.

  dba dba Back and Body Medical

  • Multi-Specialty Clinic/Center
  • New York, NY
  • NPI 1306021274

  General Practice

  Medicare reassignment Care Compare group NPD Authorized official
• Prospect Medical PC

  • Internal Medicine Physician
  • Hackensack, NJ
  • NPI 1346365905
  Medicare reassignment NPD Authorized official
• Livingston Hospital Physicians, P.a.

  • General Practice Physician
  • Livingston, NJ
  • NPI 1659372662
  Medicare reassignment NPD
• Hospital Medicine Associates, P.C.

  • Internal Medicine Physician
  • Livingston, NJ
  • NPI 1831143270
  NPD (past)
• Premier Health Center, P.C.

  • Physical Therapist
  • Hackensack, NJ
  • NPI 1134170103
  NPD (past)
• Rey Medicine PC

  dba Clifton Comprehensive Medical Center

  • Primary Care Clinic/Center
  • Clifton, NJ
  • NPI 1407090848
  NPD (past)
• Back and Body Medical

  • General Practice Physician
  • New York, NY
  • NPI 1275903999
  NPD (past)

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

{
    "created_epoch": "1126828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203638400000",
    "number": "1538154307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 W GILBERT ST",
            "city": "TINTON FALLS",
            "state": "NJ",
            "postal_code": "077014918",
            "telephone_number": "732-212-0060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "94 OLD SHORT HILLS RD",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070395672",
            "telephone_number": "201-322-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIVENDRA",
        "first_name": "SHAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-16",
        "last_updated": "2008-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA06930200",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NJ",
            "license": "25MA06930200",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8222801",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ruchika Singla, M.D.
• Samantha Sipler
• Robert Sipzner, M.D.
• Brenda C. Sison, M.D.
• Prabha Sivaprakasam
• Jennifer Nicole Sivitz, MD
• Steven Slattery
• Katherine Slazak, MD
• Sleep Atozzzs LLC
• Small & Associates, Inc. (Enable)

• Internal Medicine Physician in Livingston, NJ
• Providers in Livingston, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2008; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.