Individual provider Active NPI

Ketan D. Shah, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • North Bergen, NJ
National Provider Identifier
1609822360
Registry record updated Mar 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
25MD00270100 Issued in NJ
Practice address
9234 Kennedy Blvd
North Bergen, NJ 07047-5312
Phone
(201) 868-2400
Fax
(201) 868-2014
NPI assigned
May 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 25MD00270100 NJ Primary

Addresses

Primary practice location

9234 Kennedy Blvd
North Bergen, NJ 07047-5312

Mailing address

9234 Kennedy Blvd
North Bergen, NJ 07047-5312
Phone (201) 868-2400

Other identifiers 1

IdentifierTypeStateIssuer
8882401MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031203000535 NJ Practitioner - Podiatry 9133024151 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
New York College of Podiatric Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

9234 Kennedy Blvd
North Bergen, NJ 07047-5312
Phone (201) 868-2400

Hospital & facility affiliations

  • Palisades Medical Center Hospital, North Bergen, NJ, CCN 310003

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
0

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue22
Removal of nail tissue360

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
25MD00270100NJMDFoot & Ankle Surgery Podiatrist
005771NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Humc Opco LLC Current Accepting new patients
Achilles Foot and Ankle Group LLC Foot & Ankle Surgery CurrentSince Aug 1, 2006 Accepting new patients
Advanced Garden State Cardiology LLC PastSince Jan 1, 2025 Accepting new patients

Locations

142 Palisade Ave
Ste 220
Jersey City, NJ 07306
Phone (201) 714-4668

9234 Kennedy Blvd
North Bergen, NJ 07047
Phone (201) 868-2400

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GGAICD
  • Direct secure messaging: ketan.shah@direct.hobokenumc.md

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206921600000",
    "number": "1609822360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9234 KENNEDY BLVD",
            "city": "NORTH BERGEN",
            "state": "NJ",
            "postal_code": "070475312",
            "telephone_number": "201-868-2400",
            "fax_number": "201-868-2014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9234 KENNEDY BLVD",
            "city": "NORTH BERGEN",
            "state": "NJ",
            "postal_code": "070475312",
            "telephone_number": "201-868-2400",
            "fax_number": "201-868-2014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "KETAN",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2008-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NJ",
            "license": "25MD00270100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8882401",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Bergen, NJ

Sources for this page

Verify at the official NPI Registry.