Shelly Jain, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

036106416 Issued in IL

Practice address

104 Indian Trail Rd
Oak Brook, IL 60523-2777

Phone

(952) 595-1100

Fax

(612) 294-4903

NPI assigned

Jul 24, 2006

Last updated

Jun 23, 2015By 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 3

Addresses

Medicare fee-for-service enrollment

Enrolled in IL, WA2 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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/13693/brand/1/csg/1/fhir/r4

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.

• Fred Smeltzer MD & Associates Inc

  dba Lake of the Ozarks Radiology

  • Diagnostic Radiology Physician
  • Osage Beach, MO
  • NPI 1639122286

  IL

  Medicare reassignment NPD
• Okanogan Douglas County Hospital Dist 1

  dba Three Rivers Hospital

  • Critical Access Hospital
  • Brewster, WA
  • NPI 1205942257
  Medicare reassignment NPD
• Radiology Alliance PC

  • Diagnostic Radiology Physician
  • Nashville, TN
  • NPI 1861478489

  IL

  Medicare reassignment NPD
• Geisinger Clinic

  • Diagnostic Radiology Physician
  • Danville, PA
  • NPI 1558313023
  NPD
• Okanogan Douglas County Hospital Dist 1

  dba Three Rivers Hospital

  • Critical Access Hospital
  • Brewster, WA
  • NPI 1730293689
  NPD
• Okanogan Douglas County Hospital Dist1

  dba Three Rivers Hospital

  • Critical Access Hospital
  • Brewster, WA
  • NPI 1578649794
  NPD
• Michigan State University

  dba Michigan State University Extension

  • Local Education Agency (LEA)
  • East Lansing, MI
  • NPI 1184182982
  NPD (past)
• Mid-Michigan MRI, Inc.

  • Radiology Clinic/Center
  • Lansing, MI
  • NPI 1023061355

  Diagnostic Radiology

  NPD (past)

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435017600000",
    "number": "1588686000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11995 SINGLETREE LN",
            "address_2": "SUITE 500",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553445347",
            "telephone_number": "952-595-1301",
            "fax_number": "612-294-4903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 INDIAN TRAIL RD",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605232777",
            "telephone_number": "952-595-1100",
            "fax_number": "612-294-4903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAIN",
        "first_name": "SHELLY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-24",
        "last_updated": "2015-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "4301080021",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VT",
            "license": "042-0012213",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036106416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara B Jackson, DAOM, LAC.
• Vanessa Ann Jacobsen, PHARMD
• Helene A Jacques, LCPC
• Kianoosh Jafari, M.D.
• Ellen Jagielo, DPT
• Larry Lee James Jr., M.S., LAT, ATC
• Nicole James, LPC
• Lindsay Jana, PT, DPT
• Jeffrey Melton, M.D., S.C.
• Jennifer E Hassler LLC

• Diagnostic Radiology Physician in Oak Brook, IL
• Providers in Oak Brook, IL by specialty
• Diagnostic Radiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2015; 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.