Individual provider Active NPI

Ahmed Shahab, M.D

  • Cardiovascular Disease Physician
  • Providence, RI
National Provider Identifier
1609252329
Registry record updated Dec 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
036145640 Issued in IL
Practice address
593 Eddy St
Providence, RI 02903-4923
Phone
(401) 444-3985
Fax
(401) 444-3986
NPI assigned
Aug 4, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 22, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 036145640 IL Primary
Internal Medicine Physician 207R00000X MD16635 RI

Addresses

Primary practice location

593 Eddy St
Providence, RI 02903-4923

Mailing address

PO Box 19636
Springfield, IL 62794-9636
Phone (217) 545-8000

Other practice location 1

701 N 1st St Ste D434
Springfield, IL 62702-3757
Phone (217) 545-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
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
I20190702002703 RI Practitioner - Internal Medicine 0042520835 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD16635RIMDInternal Medicine Physician
036145640ILMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Board of Trustees of Southern Illinois University Current Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Jul 1, 2019 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Jul 1, 2019 Accepting new patients

Locations

185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

593 Eddy St
Providence, RI 02903

Interoperability endpoints

  • Direct secure messaging: ahmedshahab@siusm.allscriptsdirect.net

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1438646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766361600000",
    "number": "1609252329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19636",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949636",
            "telephone_number": "217-545-8000",
            "fax_number": "217-545-7063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "401-444-3985",
            "fax_number": "401-444-3986"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 N 1st St Ste D434",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "IL",
            "postal_code": "627023757",
            "country_code": "US",
            "telephone_number": "217-545-8000",
            "fax_number": "217-545-7063",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAHAB",
        "first_name": "AHMED",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-08-04",
        "last_updated": "2025-12-22",
        "certification_date": "2025-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036145640",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "MD16635",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.