Kishan Mitesh Shah, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD2024-0189 Issued in NM

Practice address

1353 Paseo del Pueblo Sur Ste D
Taos, NM 87571-5958

Phone

(575) 613-8090

Fax

(575) 613-8091

NPI assigned

Apr 1, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO, NM2 enrollments

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 2

Specialty

Dermatology

Education

Indiana University School of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Epiphany Dermatology of Colorado LLCGroup PAC ID 8921354341, 18 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

90.02 of 100Reported as group

Quality

84.61

Promoting interoperability

100

Improvement activities

40

Cost

82.12

Merit-based Incentive Payment System (MIPS)

Final score

95.67 of 100Reported as group

Quality

99.21

Improvement activities

40

Cost

86.61

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kshah110616@direct.phhs.org
• Direct secure messaging: kishan.shah@epiphanyderm.emadirect.md

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.

• Epiphany Dermatology of Colorado, LLC

  • Dermatology Physician
  • Denver, CO
  • NPI 1992297469
  Medicare reassignment Care Compare group
• Epiphany Dermatology of New Mexico, LLC

  • Dermatology Physician
  • Albuquerque, NM
  • NPI 1447615760
  Medicare reassignment NPD
• Elizabeth Piantanida MD PC

  dba Skin MD Dermatology and Skin Enhancement Center

  • Specialist
  • Colorado Springs, CO
  • NPI 1457792616
  NPD (past)

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

{
    "created_epoch": "1554076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729728000000",
    "number": "1710449764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 RANCH ROAD 2222, BLDG 1, STE 200",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "78730",
            "telephone_number": "512-628-0465",
            "fax_number": "512-233-2711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1353 PASEO DEL PUEBLO SUR STE D",
            "city": "TAOS",
            "state": "NM",
            "postal_code": "875715958",
            "telephone_number": "575-613-8090",
            "fax_number": "575-613-8091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "KISHAN",
        "middle_name": "MITESH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-01",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CO",
            "license": "DR.0072048",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NM",
            "license": "MD2024-0189",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jane Settree-Seitchik, LCSW
• Morgan Seubert, CPNP-PC
• SG Flourishes, Inc.
• Shadow Mountain LLC. (Shadow Mountain Recovery, Taos)
• Joshua Shaffer
• Catherine Shank
• Patrick Keenan Shanley, PA-C
• Santee N. Shanta, CASE MANAGER
• Raymond Anthony Shelko, D.D.S.
• Barbara Sherman, MA, LMFT

• Dermatology Physician in Taos, NM
• Providers in Taos, NM by specialty
• Dermatology Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; 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.