Active NPI
Anshul Mikin Shah
- Dentist
- Rockford, IL
National Provider Identifier
1639785850
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019.032920
- Practice address
- 6066 Strathmoor Dr
Rockford, IL 61107-6633 - Phone
- (815) 226-0400
- NPI assigned
- Sep 22, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.032920 | IL | Primary |
Addresses
Primary practice location
6066 Strathmoor Dr
Rockford, IL 61107-6633
Mailing address
11740 Wilshire Blvd # A1802
Los Angeles, CA 90025-6536
Phone (013) 567-1182
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210715001002 | IL | Order and Referring Only - Dentist | 7911309828 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600732800000",
"number": "1639785850",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11740 WILSHIRE BLVD # A1802",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900256536",
"telephone_number": "013-567-1182"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6066 STRATHMOOR DR",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611076633",
"telephone_number": "815-226-0400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAH",
"first_name": "ANSHUL MIKIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-09-22",
"last_updated": "2020-09-22",
"certification_date": "2020-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist",
"state": "IL",
"license": "019.032920",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2020; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.