Individual provider Active NPI

Shiva Ravanbakhsh Zargham, M.D.

  • Pediatrics Physician
  • Louisville, KY
National Provider Identifier
1558657502
Registry record updated Dec 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
48960 Issued in KY
Practice address
231 E Chestnut St
Louisville, KY 40202-1821
Phone
(502) 629-6000
Fax
(502) 629-5991
NPI assigned
Jun 28, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 48960 KY Primary

Addresses

Primary practice location

231 E Chestnut St
Louisville, KY 40202-1821

Mailing address

PO Box 909
Louisville, KY 40201-0909
Phone (502) 629-6000

Other identifiers 3

IdentifierTypeStateIssuer
7100428990MedicaidKY
1558657502MedicaidNC
201393840MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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

Enrollment IDStateProvider typePAC IDDetails
I20140912000703 NC Practitioner - Pediatric Medicine 2860611423 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Brody School of Medicine at East Carolina University, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

101 Manning Dr
Chapel Hill, NC 27514-4220
Phone (984) 974-1000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
48960KYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of North Carolina at Chapel Hill CurrentSince Aug 19, 2019 Accepting new patients
University of North Carolina at Chapel Hill Pediatrics CurrentSince Aug 19, 2019 Accepting new patients

Locations

211 Friday Center Dr
Ste 2057
Chapel Hill, NC 27517
Phone (984) 974-1281

101 Manning Dr
Chapel Hill, NC 27514
Phone (984) 974-1485

Interoperability endpoints

  • Direct secure messaging: szargham536586@direct.unc.nchie.net

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1309219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480896000000",
    "number": "1558657502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 909",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402010909",
            "telephone_number": "502-629-6000",
            "fax_number": "502-629-5991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "231 E CHESTNUT ST",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021821",
            "telephone_number": "502-629-6000",
            "fax_number": "502-629-5991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZARGHAM",
        "first_name": "SHIVA",
        "middle_name": "RAVANBAKHSH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-28",
        "last_updated": "2016-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "48960",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100428990",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1558657502",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201393840",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.