Individual provider Active NPI

Mansi R Shah, MD, MBA

  • Child & Adolescent Psychiatry Physician
  • Chicago, IL
National Provider Identifier
1679093413
Registry record updated Nov 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
036159871 Issued in IL
Practice address
2150 West Harrison Street
Chicago, IL 60612
Phone
(312) 942-5000
NPI assigned
Jun 22, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician 2084P0804X 036159871 IL Primary
Psychiatry Physician 2084P0800X 036159871 IL

Addresses

Primary practice location

2150 West Harrison Street
Chicago, IL 60612

Mailing address

4720 N Clarendon Ave
Chicago, IL 60640-5122
Phone (773) 977-4031

Other practice location 1

4720 N Clarendon Ave
Chicago, IL 60640-5122
Phone (773) 977-4031

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230308001593 IL Practitioner - Psychiatry 3375875966 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Business Administration, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036159871ILMDChild & Adolescent Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Chicago BH Hospital, LLC CurrentSince Feb 15, 2023 Accepting new patients
Chicago BH Hospital, LLC Current Accepting new patients
Chicago BH Hospital, LLC Psychiatry CurrentSince Feb 15, 2023 Accepting new patients
The Wright Center Medical Group Psychiatry PastSince Feb 24, 2022 Accepting new patients

Locations

4720 N Clarendon Ave
Chicago, IL 60640
Phone (773) 313-4401

850 W Lawrence Ave
Chicago, IL 60640
Phone (773) 357-6772

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1498089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762387200000",
    "number": "1679093413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4720 N CLARENDON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405122",
            "telephone_number": "773-977-4031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 WEST HARRISON STREET",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60612",
            "telephone_number": "312-942-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4720 N Clarendon Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606405122",
            "country_code": "US",
            "telephone_number": "773-977-4031",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAH",
        "first_name": "MANSI",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD, MBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-22",
        "last_updated": "2025-11-06",
        "certification_date": "2025-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "IL",
            "license": "036159871",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036159871",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.