NPIMap

Individual provider Active NPI

Ketankumar Shah, MD

  • Internal Medicine Physician
  • Edison, NJ
National Provider Identifier
1659761948
Registry record updated Sep 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
054281 Issued in CT
Practice address
608 Cinder Rd
Edison, NJ 08820-3373
Phone
(732) 429-5499
NPI assigned
Jan 26, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 054281 CT Primary

Addresses

Primary practice location

608 Cinder Rd
Edison, NJ 08820-3373

Mailing address

608 Cinder Rd
Edison, NJ 08820-3373
Phone (732) 429-5499

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, NJ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150925001565 CT Practitioner - Internal Medicine 7113235011 Reassigns benefits to 6 organizations
I20160122000709 NJ Practitioner - Internal Medicine 7113235011 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The William W Backus HospitalGroup PAC ID 0749170645, 248 clinicians
Hospitalist Physicians of New Jersey PAGroup PAC ID 3476859927, 162 clinicians

Practice addresses (Care Compare)

326 Washington St
Norwich, CT 06360-2740
Phone (860) 889-8331

65 James St
Edison, NJ 08820-3947
Phone (732) 321-7000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.8 of 100Reported as group
Quality
90
Promoting interoperability
100
Improvement activities
40
Cost
78.43

Merit-based Incentive Payment System (MIPS)

Final score
97.64 of 100Reported as group
Quality
79.59
Promoting interoperability
100
Improvement activities
40
Cost
81.22

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
054281CTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bristol Hospital Incorporated CurrentSince Aug 1, 2024 Accepting new patients
Hospitalist Physicians of New Jersey PA Internal Medicine CurrentSince Feb 1, 2016 Accepting new patients
Optum Medical Care of New Jersey PC CurrentSince Apr 24, 2018 Accepting new patients
Midstate Medical Center CurrentSince Mar 6, 2018 Accepting new patients
Windham Community Memorial Hospital, Inc. CurrentSince Mar 1, 2016 Accepting new patients
Midstate Medical Center CurrentSince Mar 6, 2018 Accepting new patients
William W Backus Hospital CurrentSince Nov 14, 2015 Accepting new patients
The William W Backus Hospital CurrentSince Nov 14, 2015 Accepting new patients
Bristol Hospital Multi Specialty Group, Inc Internal Medicine CurrentSince Apr 20, 2020 Accepting new patients
Midstate Medical Center Current Accepting new patients
Optum Medical Care of New Jersey PC Internal Medicine CurrentSince Apr 24, 2018 Accepting new patients
Neighborhood Health, Inc. Internal Medicine CurrentSince Jul 30, 2015 Accepting new patients

Locations

2800 Main St
Bridgeport, CT 06606
Phone (203) 386-0366

41 Brewster Rd
Bristol, CT 06010
Phone (800) 585-3000

420 N Main St
Bristol, CT 06010
Phone (860) 314-4400

15 Riverside Ave
Bristol, CT 06010
Phone (860) 516-7593

435 Lewis Ave
Meriden, CT 06451
Phone (203) 284-1340

326 Washington St
Norwich, CT 06360
Phone (860) 701-0140

1290 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 972-6977

112 Mansfield Ave
Willimantic, CT 06226
Phone (830) 423-6410

935 River Rd
Ste 301
Edgewater, NJ 07020
Phone (201) 471-7012

65 James St
Edison, NJ 08820
Phone (732) 321-7010

3403 S Delsea Dr
Vineland, NJ 08360
Phone (856) 293-6974

Interoperability endpoints

  • Direct secure messaging: ketankumar.shah@xdr.hhchealthdirect.org

Organizations & group practices 12

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": "1422230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441065600000",
    "number": "1659761948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 CINDER RD",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088203373",
            "telephone_number": "732-429-5499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 CINDER RD",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088203373",
            "telephone_number": "732-429-5499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "KETANKUMAR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-01-26",
        "last_updated": "2015-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "054281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edison, NJ

Sources for this page

Verify at the official NPI Registry.