Individual provider Active NPI

Shahryar Tork, MD

  • Plastic Surgery Physician
  • Cincinnati, OH
National Provider Identifier
1699063057
Registry record updated Aug 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
35.130656 Issued in OH
Practice address
7136 Miami Ave
Cincinnati, OH 45243-2617
Phone
(513) 513-0460
NPI assigned
Jul 19, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 11, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X TP734 KY
Plastic Surgery Physician 208200000X 35132372 OH
Plastic Surgery Physician 208200000X 53280 KY
Plastic Surgery Physician 208200000X 35.130656 OH Primary

Addresses

Primary practice location

7136 Miami Ave
Cincinnati, OH 45243-2617

Mailing address

8404 Eustis Farm LN
Cincinnati, OH 45243-4214
Phone (917) 868-7875

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
TP734KYMDOrthopaedic Hand Surgery Physician
53280KYMDPlastic Surgery Physician
35.130656OHMDPlastic Surgery Physician
35132372OHMDPlastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Plastic Surgery Group PastSince Sep 23, 2019 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: stork666388@direct.bsmhealth.org

Organizations & group practices 1

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": "1311033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723334400000",
    "number": "1699063057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8404 EUSTIS FARM LN",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452434214",
            "telephone_number": "917-868-7875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7136 MIAMI AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452432617",
            "telephone_number": "513-513-0460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TORK",
        "first_name": "SHAHRYAR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-19",
        "last_updated": "2024-08-11",
        "certification_date": "2024-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "KY",
            "license": "TP734",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "OH",
            "license": "35132372",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "KY",
            "license": "53280",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "OH",
            "license": "35.130656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2024; 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.