Riddhi Jay Shah, D.O.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

5101020760 Issued in MI

Practice address

3901 Stonegate Park
Suite 300
Saint Joseph, MI 49085-9137

Phone

(269) 408-4265

Fax

(269) 556-6020

NPI assigned

Feb 12, 2007

Last updated

Aug 19, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Dermatology

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prosperity Medical, PLLCGroup PAC ID 2769828474, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lakeland Hospital, St Joseph Hospital, St Joseph, MI, CCN 230021

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rjshah@stonegatedermatologyandmedicalspa.emadirect.md

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.

• Prosperity Medical, PLLC

  dba Stonegate Dermatology and Medical Spa

  • Dermatology Physician
  • Saint Joseph, MI
  • NPI 1528837218
  Medicare reassignment Care Compare group NPD Authorized official
• Lakeland Medical Practices

  dba Corewell Health Medical Group South

  • Internal Medicine Physician
  • Saint Joseph, MI
  • NPI 1538397120
  Medicare reassignment NPD
• Lakeland Medical Practices

  dba Corewell Health Medical Group South

  • Internal Medicine Physician
  • Bridgman, MI
  • NPI 1568232247
  NPD

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

• Lakeland Hospitals at Niles and St Joseph, Inc

  dba Corewell Health Lakeland Hospitals

  • General Acute Care Hospital
  • Saint Joseph, MI
  • NPI 1134220031
  Care Compare affiliation

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471564800000",
    "number": "1568504397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 STONEGATE PARK",
            "address_2": "SUITE 300",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490859137",
            "telephone_number": "269-408-4265",
            "fax_number": "269-556-6020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 STONEGATE PARK",
            "address_2": "SUITE 300",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490859137",
            "telephone_number": "269-408-4265",
            "fax_number": "269-556-6020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "RIDDHI",
        "middle_name": "JAY",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-12",
        "last_updated": "2016-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "011440",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0003431",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MI",
            "license": "5101020760",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "OH",
            "license": "58.004442",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1568504397",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ryan Douglas Shafer
• Jayce Shaffer
• Aanal Shah, FNP-C
• Ami Shah, MD
• Mukund Shah, M.D.
• Shannon L Groh, Ma, LPC Counseling, PLLC
• Sharkey Chiropractic P.C. (HealthSource of St. Joseph)
• Kushagra Sharma
• Tushar D Sharma
• Subramaniam R Shastri, MD

• Dermatology Physician in Saint Joseph, MI
• Providers in Saint Joseph, MI by specialty
• Dermatology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2016; 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.