Pediatric Medical Group Inc

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

PEDIATRIC MEDICAL GROUP INC

Practice address

2814 Theater Ave
Huntington, IN 46750-7978

Phone

(260) 356-3611

Fax

(260) 358-4263

NPI assigned

Dec 12, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Piyush J Shah, MD

Title

President

Phone

(260) 356-3611

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361232000000",
    "number": "1689735110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2814 THEATER AVE",
            "city": "HUNTINGTON",
            "state": "IN",
            "postal_code": "467507978",
            "telephone_number": "260-356-3611",
            "fax_number": "260-358-4263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2814 THEATER AVE",
            "city": "HUNTINGTON",
            "state": "IN",
            "postal_code": "467507978",
            "telephone_number": "260-356-3611",
            "fax_number": "260-358-4263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2013-02-19",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "PIYUSH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "260-356-3611",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100138140A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Huntington, IN
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.