Raju Kirtikumar Shah, MD

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

License

036143438 Issued in IL

Practice address

5101 Willow Springs Rd
2ND Floor
La Grange, IL 60525-2600

Phone

(708) 245-8900

Fax

(708) 245-5604

NPI assigned

Jul 1, 2014

Last updated

Sep 4, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Thomas J Cahill PHD PC

  • Clinical Psychologist
  • La Grange, IL
  • NPI 1710179288
  NPD (past)

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

{
    "created_epoch": "1404172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536019200000",
    "number": "1669888491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4461 PROGRESS BLVD",
            "city": "PERU",
            "state": "IL",
            "postal_code": "613541109",
            "telephone_number": "815-223-9683",
            "fax_number": "815-223-9683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5101 WILLOW SPRINGS RD",
            "address_2": "2ND FLOOR",
            "city": "LA GRANGE",
            "state": "IL",
            "postal_code": "605252600",
            "telephone_number": "708-245-8900",
            "fax_number": "708-245-5604"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5101 Willow Springs Rd",
            "address_2": "2ND FLOOR",
            "address_purpose": "LOCATION",
            "city": "LA Grange",
            "state": "IL",
            "postal_code": "605252600",
            "country_code": "US",
            "telephone_number": "708-245-8900",
            "fax_number": "708-245-5604",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4461 Progress Blvd",
            "address_purpose": "LOCATION",
            "city": "Peru",
            "state": "IL",
            "postal_code": "613541109",
            "country_code": "US",
            "telephone_number": "815-223-9683",
            "fax_number": "815-223-9683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAH",
        "first_name": "RAJU",
        "middle_name": "KIRTIKUMAR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-01",
        "last_updated": "2018-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": "125065796",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "IL",
            "license": "036143438",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Megumi Serikaku, OTR/L
• Jazmin De Maria Serna, DMD
• Alyssa Marie Serveiss, PT
• Alap Pradip Shah, M.D.
• Aneri Nitish Shah, DO
• Reema Shah, MD
• Hooman Shams, DO
• Elham Yahya Sharaf -Eldeen, DMD
• Amanda M Sicking, SLP
• Julia Gabrielle Chanco Sim, OTD

• Geriatric Medicine (Family Medicine) Physician in La Grange, IL
• Providers in La Grange, IL by specialty
• Geriatric Medicine (Family Medicine) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2018; 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.

Verify at the official NPI Registry.