Active NPI
Shafique Ahmad, MD
- Pediatrics Physician
- Granite City, IL
National Provider Identifier
1700973229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 036048376
- Practice address
- 3165 Myrtle Ave
Suite 2
Granite City, IL 62040-5012 - Phone
- (618) 876-7500
- Fax
- (618) 876-0807
- NPI assigned
- Oct 6, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 036048376 | IL | Primary |
Addresses
Primary practice location
3165 Myrtle Ave
Suite 2
Granite City, IL 62040-5012
Mailing address
3165 Myrtle Ave
Suite 2
Granite City, IL 62040-5012
Phone (618) 876-7500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036048376 | Medicaid | IL |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036048376 | IL | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| SSM Cardinal Glennon Children'S Hospital | Pediatrics | Past | Accepting new patients |
| SSM Cardinal Glennon Childrens Hospital | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- ahmads@yourcarecommunity.org
Organizations & group practices 2
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.
-
- Pediatrics Physician
- Warrenton, MO
- NPI 1962573212
Pediatrics
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1422230400000",
"number": "1700973229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3165 MYRTLE AVE",
"address_2": "SUITE 2",
"city": "GRANITE CITY",
"state": "IL",
"postal_code": "620405012",
"telephone_number": "618-876-7500",
"fax_number": "618-876-0807"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3165 MYRTLE AVE",
"address_2": "SUITE 2",
"city": "GRANITE CITY",
"state": "IL",
"postal_code": "620405012",
"telephone_number": "618-876-7500",
"fax_number": "618-876-0807"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AHMAD",
"first_name": "SHAFIQUE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-06",
"last_updated": "2015-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036048376",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036048376",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Granite City, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.