Vibhakar Shantilal Shah, M.D.

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

036053632 Issued in IL

Practice address

222 S Greenleaf St
Suite No. 109
Gurnee, IL 60031-5705

Phone

(847) 249-0167

Fax

(847) 249-0717

NPI assigned

Oct 12, 2005

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 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/2069/brand/1/csg/29/fhir/r4

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.

• Vibhakar S Shah M.D., S.C.

  • Specialist
  • Gurnee, IL
  • NPI 1467647099
  NPD (past) Authorized official
• Waukegan Clinic Corp

  • Family Medicine Physician
  • Waukegan, IL
  • NPI 1306937289
  NPD (past)

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200009600000",
    "number": "1649268780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 S GREENLEAF ST",
            "address_2": "SUITE NO. 109",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315705",
            "telephone_number": "847-249-0167",
            "fax_number": "847-249-0717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 S GREENLEAF ST",
            "address_2": "SUITE NO. 109",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315705",
            "telephone_number": "847-249-0167",
            "fax_number": "847-249-0717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "VIBHAKAR",
        "middle_name": "SHANTILAL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-12",
        "last_updated": "2008-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IL",
            "license": "036053632",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "791041099",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "L009488",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036053632",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "0004900801",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aisha Sethi, M.D
• Lisa Shaffer, DPT
• Sarah Shaffer, ATC, LAT
• Dilip Kantilal Shah, MD
• Parthiv Shah, M.D.
• Shaku Chhabria Neurological Services SC
• Rita Shamon, NP
• Julie Shapiro, MD
• Shari L. Bornstein MD
• K. Shaver

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2008; 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.