Individual provider Active NPI

Raina Shivashankar, MD

  • Gastroenterology Physician
  • Philadelphia, PA
National Provider Identifier
1699096347
Registry record updated Oct 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
MD456659 Issued in PA
Practice address
1101 Chestnut St
Philadelphia, PA 19107-3612
Phone
(215) 955-8900
Fax
(215) 923-3447
NPI assigned
Jun 17, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2024

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 54258 MN
Gastroenterology Physician 207RG0100X 54258 MN
Gastroenterology Physician 207RG0100X MD456659 PA Primary

Addresses

Primary practice location

1101 Chestnut St
Philadelphia, PA 19107-3612

Mailing address

132 S 10TH St
480 Main Building
Philadelphia, PA 19107-5244
Phone (215) 955-8900

Other identifiers 1

IdentifierTypeStateIssuer
P01105546OtherMNMEDICARE RAILROAD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160531002410 PA Practitioner - Gastroenterology 6305018953 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Hahnemann University College of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

132 S 10TH St
Philadelphia, PA 19107-5244
Phone (215) 955-8900

Hospital & facility affiliations

  • Thomas Jefferson University Hospital Hospital, Philadelphia, PA, CCN 390174

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy37
Upper gastrointestinal (GI) endoscopy for acid reflux21

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
54258MNMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn - Medical Group Gastroenterology CurrentSince Jul 1, 2016 Accepting new patients
University of Penn-Medical Group CurrentSince Jul 1, 2016 Accepting new patients
Jefferson University Physicians Internal Medicine CurrentSince May 1, 2017 Accepting new patients
Jefferson University Physicians Gastroenterology Past Accepting new patients
University of Penn - Medical Group Past Accepting new patients

Locations

3400 Spruce St
Fl 3
Philadelphia, PA 19104

132 S 10th St
Fl 4
Philadelphia, PA 19107

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

1101 Chestnut St
Philadelphia, PA 19107
Phone (215) 955-6760

1101 Chestnut St
#8
Philadelphia, PA 19107
Phone (215) 955-5869

3624 Market St
Fl 2
Philadelphia, PA 19104
Phone (215) 615-3669

132 S 10th St
#480
Philadelphia, PA 19107
Phone (215) 955-3947

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1276732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1699096347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "132 S 10TH ST",
            "address_2": "480 MAIN BUILDING",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075244",
            "telephone_number": "215-955-8900",
            "fax_number": "215-923-3447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 CHESTNUT ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191073612",
            "telephone_number": "215-955-8900",
            "fax_number": "215-923-3447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIVASHANKAR",
        "first_name": "RAINA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-17",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "54258",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MN",
            "license": "54258",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "PA",
            "license": "MD456659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P01105546",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.