Active NPI
Morteza Shafa, M.D.
- Family Medicine Physician
- La Center, KY
National Provider Identifier
1669407458
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(4) exclusion effective Feb 20, 2011.
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 22367
- Practice address
- 245 Broadway St.
La Center, KY 42056 - Phone
- (270) 665-9195
- Fax
- (270) 665-5420
- NPI assigned
- Jul 11, 2006
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 22367 | KY | Primary |
Addresses
Primary practice location
245 Broadway St.
La Center, KY 42056
Mailing address
PO Box 180
La Center, KY 42056-0180
Phone (270) 665-9195
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64223670 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22367 | KY | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1669407458",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 180",
"city": "LA CENTER",
"state": "KY",
"postal_code": "420560180",
"telephone_number": "270-665-9195",
"fax_number": "270-665-5420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "245 BROADWAY ST.",
"city": "LA CENTER",
"state": "KY",
"postal_code": "42056",
"telephone_number": "270-665-9195",
"fax_number": "270-665-5420"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAFA",
"first_name": "MORTEZA",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "KY",
"license": "22367",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64223670",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in La Center, KY
- Rebecca Lorraine Hafford, COTA
- La Center Operations, LLC (Life Care Center of La Center)
- Life Care Centers of America, Inc. (Life Care Center of La Center)
- Purchase District Health Dept
- Wendy Renfrow, PHARMD
- Sutton Drugs of la Center Inc
- Sutton Drugs of la Center Inc (Sutton Drugs)
- Sutton Drugs of Lacenter Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.