Jitendra J Shah, MD

Primary specialty

Pediatric Cardiology PhysicianTaxonomy code 2080P0202X

License

036-053972 Issued in IL

Practice address

420 NE Glen Oak Ave
Suite 304
Peoria, IL 61603-3105

Phone

(309) 655-3453

Fax

(309) 655-2938

NPI assigned

Oct 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Gibson Community Hospital Association

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)
• Pediatric Cardiology Associates SC

  • Pediatric Cardiology Physician
  • Peoria, IL
  • NPI 1205863578
  NPD (past)

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346112000000",
    "number": "1619061827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 NE GLEN OAK AVE",
            "address_2": "SUITE 304",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033105",
            "telephone_number": "309-655-3453",
            "fax_number": "309-655-2938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 NE GLEN OAK AVE",
            "address_2": "SUITE 304",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033105",
            "telephone_number": "309-655-3453",
            "fax_number": "309-655-2938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "JITENDRA",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2012-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "IL",
            "license": "036-053972",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036053972",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Terri Fran Shafer, LCPC
• Mary Shah-Cox, D.D.S.
• Anushi Shah, M.D.
• Darshana Vijay Shah, HOME CARE PROVIDER
• Jenny Kunvarji Shah, CRNA APN
• Pulin Shah, M.D.
• Riaz Shah, MD
• Vikram Shah, RPH
• Leena Shahbaz
• Maham Shahid, MD

• Pediatric Cardiology Physician in Peoria, IL
• Providers in Peoria, IL by specialty
• Pediatric Cardiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.