NPIMap

Individual provider Active NPI

Pavani Thotakura Shah, M.D.

  • Diagnostic Radiology Physician
  • Greenville, SC
National Provider Identifier
1689920464
Registry record updated Dec 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
82380 Issued in SC
Practice address
1210 W Faris Rd
Greenville, SC 29605-4444
Phone
(864) 522-1800
Fax
(864) 522-1806
NPI assigned
Jul 30, 2012
Last updated
Dec 7, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 7, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125.060992 IL
Diagnostic Radiology Physician 2085R0202X 2017-01250 NC
Diagnostic Radiology Physician 2085R0202X 82380 SC Primary

Addresses

Primary practice location

1210 W Faris Rd
Greenville, SC 29605-4444

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 522-8603

Other practice location 1

Wake Forest Baptist Health House Staff Ofc
Medical Center Blvd.
Winston Salem, NC 27157-0001
Phone (336) 716-3465

Other identifiers 1

IdentifierTypeStateIssuer
10118QMedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pshah264753@direct.ghs.myhfn.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20191003000880 SC Practitioner - Diagnostic Radiology 4587974340 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prisma Health University Medical GroupGroup PAC ID 8325950983, shared by 5 NPIs, 2,467 clinicians

Practice addresses (Care Compare)

1210 W Faris Rd
Greenville, SC 29605-4444
Phone (864) 522-1800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125.060992ILMDInternal Medicine Physician
2017-01250NCMDDiagnostic Radiology Physician
82380SCMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health University Medical Group CurrentSince Aug 12, 2019 Accepting new patients
Prisma Health University Medical Group Diagnostic Radiology CurrentSince Aug 12, 2019 Accepting new patients
Prisma Health University Medical Group Diagnostic Radiology CurrentSince Sep 8, 2022 Accepting new patients

Locations

1519 Marion St
Columbia, SC 29201
Phone (803) 296-5513

1 Independence Pt
Ste 212
Greenville, SC 29615
Phone (864) 797-6306

1210 W Faris Rd
Greenville, SC 29605
Phone (864) 295-4410

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

Organizations & group practices 3

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.

Hospital & facility affiliations 56

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

View all 56

NPI Registry JSON

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

{
    "created_epoch": "1343606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670371200000",
    "number": "1689920464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-522-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 W FARIS RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054444",
            "telephone_number": "864-522-1800",
            "fax_number": "864-522-1806"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Wake Forest Baptist Health House Staff Ofc",
            "address_2": "Medical Center Blvd.",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271570001",
            "country_code": "US",
            "telephone_number": "336-716-3465",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAH",
        "first_name": "PAVANI",
        "middle_name": "THOTAKURA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-30",
        "last_updated": "2022-12-07",
        "certification_date": "2022-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125.060992",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "2017-01250",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "SC",
            "license": "82380",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10118Q",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pshah264753@direct.ghs.myhfn.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "pshah264753@direct.ghs.myhfn.org",
            "address_1": "1210 W Faris Rd",
            "city": "Greenville",
            "state": "SC",
            "country_code": "US",
            "postal_code": "296054444",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.