NPIMap

Individual provider Active NPI

Sanjay Shah, M.D.

  • Internal Medicine Physician
  • Fayetteville, NC
National Provider Identifier
1689604035
Registry record updated Jun 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
9801484 Issued in NC
Practice address
1218 Walter Reed Rd
Fayetteville, NC 28304-4440
Phone
(910) 323-1671
Fax
(910) 323-9656
NPI assigned
Jul 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Anesthesiology) Physician 207LH0002X 9801484 NC
Nephrology Physician 207RN0300X 9801484 NC
Internal Medicine Physician 207R00000X 9801484 NC Primary

Addresses

Primary practice location

1218 Walter Reed Rd
Fayetteville, NC 28304-4440

Mailing address

Attn. Managed Care Planning
PO Box 40908
Fayetteville, NC 28309
Phone (910) 615-6949

Other identifiers 2

IdentifierTypeStateIssuer
8911560MedicaidNC
390007497OtherNCMEDICARE RAILROAD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080326000703 NC Practitioner - Internal MedicinePractitioner - Hospice/Palliative CarePractitioner - Nephrology 8628075769 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hospice/Palliative Care, Nephrology
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cumberland County Hospital System IncGroup PAC ID 1850204041, 581 clinicians
North Carolina Nephrology PAGroup PAC ID 0244511483, 58 clinicians

Practice addresses (Care Compare)

1638 Owen Dr
Fayetteville, NC 28304-3424
Phone (910) 615-8000

2824 Rogers Rd
Suite 104
Wake Forest, NC 27587-3896
Phone (919) 876-7807

700 Tilghman Dr
Suite 722
Dunn, NC 28334-5519
Phone (919) 876-7807

Hospital & facility affiliations

  • Cape Fear Valley Medical Center Hospital, Fayetteville, NC, CCN 340028
  • Cape Fear Valley Hoke Hospital Hospital, Raeford, NC, CCN 340188
  • Betsy Johnson Regional Hospital Hospital, Dunn, NC, CCN 340071

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
North Carolina Nephrology PA Nephrology CurrentSince May 1, 2020 Accepting new patients
Cumberland County Hospital System Inc Current Accepting new patients
Cumberland County Hospital System Inc CurrentSince Sep 1, 2016 Accepting new patients
Cumberland County Hospital System Inc CurrentSince Sep 1, 2016 Accepting new patients
North Carolina Nephrology PA Nephrology CurrentSince May 1, 2020 Accepting new patients

Locations

145 Tilghman Dr
Ste 300
Dunn, NC 28334
Phone (910) 891-5437

1638 Owen Dr
Fayetteville, NC 28304
Phone (910) 609-5610

1218 Walter Reed Rd
Fayetteville, NC 28304
Phone (910) 323-1671

3031 New Bern Ave
Ste 306
Raleigh, NC 27610
Phone (919) 459-8409

2824 Rogers Rd
Ste 104
Wake Forest, NC 27587

Interoperability endpoints

  • Direct secure messaging: sshah24290@direct.acumenmd.com

Organizations & group practices 5

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 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560988800000",
    "number": "1689604035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ATTN. MANAGED CARE PLANNING",
            "address_2": "PO BOX 40908",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "28309",
            "telephone_number": "910-615-6949",
            "fax_number": "910-615-9761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1218 WALTER REED RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044440",
            "telephone_number": "910-323-1671",
            "fax_number": "910-323-9656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "SANJAY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2019-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LH0002X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Hospice and Palliative Medicine",
            "state": "NC",
            "license": "9801484",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NC",
            "license": "9801484",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "9801484",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8911560",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "390007497",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.