NPIMap

Individual provider Active NPI

Rajeev Shukla, MD

  • Internal Medicine Physician
  • Lodi, CA
National Provider Identifier
1548289630
Registry record updated Sep 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A51690 Issued in CA
Practice address
845 S Fairmont Ave
Suite 1
Lodi, CA 95240-5113
Phone
(209) 224-5385
NPI assigned
Jul 19, 2006
Last updated
Sep 10, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A51690 CA Primary

Addresses

Primary practice location

845 S Fairmont Ave
Suite 1
Lodi, CA 95240-5113

Mailing address

845 S Fairmont Ave Ste 1
Lodi, CA 95240-5113
Phone (209) 712-7017

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20090122000459 CA Practitioner - Internal MedicinePractitioner - Family Practice 7911061718 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Family Practice
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

845 S Fairmont Ave
Suite 1
Lodi, CA 95240-5113
Phone (209) 224-5385

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions57
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A51690CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rajeev Shukla MD Inc Internal Medicine CurrentSince May 9, 2011 Accepting new patients
Waleed Ibrahim M.D., Inc. PastSince May 9, 2011 Accepting new patients
Lodi Memorial Hospital Association Inc Past Accepting new patients

Locations

845 S Fairmont Ave
Ste 1
Lodi, CA 95240
Phone (209) 224-5385

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

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 19

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725926400000",
    "number": "1548289630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 S FAIRMONT AVE STE 1",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405113",
            "telephone_number": "209-712-7017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 S FAIRMONT AVE",
            "address_2": "SUITE 1",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405113",
            "telephone_number": "209-224-5385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUKLA",
        "first_name": "RAJEEV",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A51690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lodi, CA

Sources for this page

Verify at the official NPI Registry.