Ketan Mahendra Shah, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

209008868 Issued in IL

Practice address

111 N County Farm Rd
Wheaton, IL 60187-3977

Phone

(630) 682-7400

NPI assigned

Oct 18, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Rush Medical College of Rush University, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

County of Dupage Department of HealthGroup PAC ID 4981695103, 30 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• County of Dupage Department of Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wheaton, IL
  • NPI 1134110786
  Medicare reassignment Care Compare group NPD
• County of Dupage Department of Health

  • Health Service Clinic/Center
  • Wheaton, IL
  • NPI 1932892999
  NPD

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

{
    "created_epoch": "1318896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633392000000",
    "number": "1689959900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 N COUNTY FARM RD",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601873977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 N COUNTY FARM RD",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601873977",
            "telephone_number": "630-682-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "KETAN",
        "middle_name": "MAHENDRA",
        "name_prefix": "Mr.",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-18",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209008868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• SG Counseling PLLC
• Nura Shadid, MSW
• Rita Anne Shadle
• Dipti V Shah, R.D.
• Kavita Shah
• Komal Shah
• Priya Shah
• Darrin Jihad Shahid
• Mya Eugena Shaikh, PMHNP-BC
• Keely Sharkey

• Psychiatric/Mental Health Nurse Practitioner in Wheaton, IL
• Providers in Wheaton, IL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.