Mohammad R Shaker, M.D.

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

036-105323 Issued in IL

Practice address

1150 Essington Rd Ste 101
Joliet, IL 60435-8447

Phone

(888) 938-3838

Fax

(888) 919-1083

NPI assigned

Jan 23, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 5

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in WI, IL2 enrollments

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 2

Specialty

Otolaryngology

Education

Baylor College of Medicine, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Ear Nose and Throat Specialists PLLCGroup PAC ID 0143657197, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mshaker109511@direct.myadvocateaurora.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advanced Ear Nose & Throat Specialists, PLLC

  dba Advent

  • Otolaryngology Physician
  • Vernon Hills, IL
  • NPI 1184281735
  Medicare reassignment Care Compare group NPD
• Dean Health Systems, Inc

  dba SSM Health Dean Medical Group

  • Allergy & Immunology Physician
  • Madison, WI
  • NPI 1053358846
  Medicare reassignment NPD
• Mercy Health System Corporation

  dba MHS Physician Services

  • Multi-Specialty Clinic/Center
  • Janesville, WI
  • NPI 1598718603
  Medicare reassignment NPD
• Dakota Ear Nose & Throat Clinic

  • Otolaryngology Physician
  • Huron, SD
  • NPI 1558434712
  NPD (past) Authorized official
• Dean Health Systems, Inc.

  dba SSM Health Davis Duehr Dean Eye Care - Portage

  • Durable Medical Equipment & Medical Supplies
  • Portage, WI
  • NPI 1427085679
  NPD
• Mercy Health System Corporation

  dba Mercy Walworth Hospital and Medical Center

  • Critical Access Hospital
  • Lake Geneva, WI
  • NPI 1699728550
  NPD
• KSB Medical Group, Inc.

  • Family Medicine Physician
  • Dixon, IL
  • NPI 1073592119

  Otolaryngology

  NPD (past)

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1639223928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "888-720-2012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 ESSINGTON RD STE 101",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604358447",
            "telephone_number": "888-938-3838",
            "fax_number": "888-919-1083"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17859 80th Ave",
            "address_purpose": "LOCATION",
            "city": "Tinley Park",
            "state": "IL",
            "postal_code": "604775023",
            "country_code": "US",
            "telephone_number": "888-938-3838",
            "fax_number": "888-919-1083",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13250 Washington Ave",
            "address_purpose": "LOCATION",
            "city": "Mount Pleasant",
            "state": "WI",
            "postal_code": "531771516",
            "country_code": "US",
            "telephone_number": "888-720-2012",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAKER",
        "first_name": "MOHAMMAD",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-23",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "WI",
            "license": "48503020",
            "primary": false
        },
        {
            "code": "207YX0901X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otology & Neurotology",
            "state": "WI",
            "license": "48503",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IL",
            "license": "036-105323",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036105323",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34689900",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6520350",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK",
            "identifier": "0022505",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAKOTA CARE",
            "identifier": "9213433",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mshaker109511@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "8400 Washington Ave",
            "city": "Mount Pleasant",
            "state": "WI",
            "country_code": "US",
            "postal_code": "534063735",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "8400 Washington Ave",
            "city": "Mount Pleasant",
            "state": "WI",
            "country_code": "US",
            "postal_code": "534063735",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mohammad Sameer Shafi, M.D.
• Bhavin Chandrakant Shah, MD
• Kalpana Tushar Shah, D.M.D.
• Niraj Yatin Shah, M.D.
• Yatin Shah, M.D.
• Katie Shank, M.H.S.
• Danellyn Janette Shannon, L.C.S.W.
• Shari Valdes (Share Care Agency)
• Anuj Sharma, DDS
• Bikram Sharma, MD

• Otolaryngology Physician in Joliet, IL
• Providers in Joliet, IL by specialty
• Otolaryngology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.