NPIMap

Individual provider Active NPI

Manish M Shukla, MD

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1619983558
Registry record updated Jan 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036098634 Issued in IL
Practice address
3943 W 31St St
St Jude Medical Center
Chicago, IL 60623-4936
Phone
(773) 523-8773
Fax
(773) 523-9259
NPI assigned
Jul 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036098634 IL Primary

Addresses

Primary practice location

3943 W 31St St
St Jude Medical Center
Chicago, IL 60623-4936

Mailing address

3943 W 31St St
Chicago, IL 60623-4936
Phone (773) 523-8773

Other identifiers 1

IdentifierTypeStateIssuer
036098634MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20110516000758 IL Practitioner - Family Practice 2062586704 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

3943 W 31St St
Chicago, IL 60623-4936
Phone 77352387734

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036098634ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Jude Medical Clinic SC Family Medicine CurrentSince Feb 22, 2011 Accepting new patients

Locations

3943 W 31st St
Chicago, IL 60623
Phone (773) 523-8773

Organizations & group practices 1

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 10

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": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580428800000",
    "number": "1619983558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3943 W 31ST ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606234936",
            "telephone_number": "773-523-8773",
            "fax_number": "773-523-9259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3943 W 31ST ST",
            "address_2": "ST JUDE MEDICAL CENTER",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606234936",
            "telephone_number": "773-523-8773",
            "fax_number": "773-523-9259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUKLA",
        "first_name": "MANISH",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2020-01-31",
        "certification_date": "2020-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036098634",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036098634",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.