NPIMap

Individual provider Active NPI

Siddharth Kirit Shah, M.D.

  • Psychiatry Physician
  • Mableton, GA
National Provider Identifier
1619331147
Registry record updated Jun 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
82172 Issued in GA
Practice address
6360 Mableton Pkwy SW
Mableton, GA 30126-5210
Phone
(770) 948-8600
NPI assigned
Apr 11, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 24, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Psychiatry Physician 2084P0800X 82172 GA Primary

Addresses

Primary practice location

6360 Mableton Pkwy SW
Mableton, GA 30126-5210

Mailing address

6360 Mableton Pkwy SW
Mableton, GA 30126-5210
Phone (770) 948-8600

Other practice location 1

720 Westview Dr SW
Atlanta, GA 30310-1458
Phone (404) 756-1451

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201221001737 FL Practitioner - PsychiatryPractitioner - Neurology 8820384225 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Orlando Health Medical Group IncGroup PAC ID 9537059084, 2,171 clinicians

Practice addresses (Care Compare)

555 W State Rd
Suite 434
Longwood, FL 32750-5119
Phone (321) 842-2994

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.91 of 100Reported as group
Quality
61.18
Promoting interoperability
100
Improvement activities
40
Cost
71.86

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
82172GAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Health, Inc. Current Accepting new patients
Orlando Health Medical Group Inc CurrentSince Jan 4, 2021 Accepting new patients
Orlando Health Medical Group Inc CurrentSince Jan 4, 2021 Accepting new patients
Kiritkumar J. Shah, M.D.,PC Psychiatry PastSince Jun 28, 2020 Accepting new patients

Locations

555 W State Road 434
Longwood, FL 32750
Phone (407) 767-1200

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

Interoperability endpoints

  • Direct secure messaging: sshah129079@orlandohealth.medalliesdirect.net

Organizations & group practices 4

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 5

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": "1460332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592956800000",
    "number": "1619331147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6360 MABLETON PKWY SW",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "301265210",
            "telephone_number": "770-948-8600",
            "fax_number": "770-944-7900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6360 MABLETON PKWY SW",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "301265210",
            "telephone_number": "770-948-8600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "720 Westview Dr SW",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303101458",
            "country_code": "US",
            "telephone_number": "404-756-1451",
            "fax_number": "404-756-1471",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAH",
        "first_name": "SIDDHARTH",
        "middle_name": "KIRIT",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-04-11",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "GA",
            "license": "82172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mableton, GA

Sources for this page

Verify at the official NPI Registry.