Individual provider Active NPI

Mital Shah, M.M.S,.P.A-C

  • Physician Assistant
  • Phoenix, AZ
National Provider Identifier
1720268618
Registry record updated Nov 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2740 Issued in AZ
Practice address
755 E McDowell Rd FL 4
Phoenix, AZ 85006-2506
Phone
(602) 521-3090
Fax
(602) 521-3661
NPI assigned
Nov 7, 2007
Last updated
Nov 19, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA189433 OR
Physician Assistant 363A00000X 2740 AZ Primary

Addresses

Primary practice location

755 E McDowell Rd FL 4
Phoenix, AZ 85006-2506

Mailing address

755 E McDowell Rd FL 4
Phoenix, AZ 85006-2506
Phone (602) 521-3090

Other identifiers 2

IdentifierTypeStateIssuer
500756270MedicaidOR
PA 17915OtherCAPHYSICIAN ASSISTANT COMMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, OR2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20050908000594 AZ Practitioner - Physician Assistant 6406888668 Reassigns benefits to 1 organization
I20181217002733 OR Practitioner - Physician Assistant 6406888668 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1111 E McDowell Rd
Phoenix, AZ 85006-2612
Phone (602) 839-2000

1300 N 12TH St
Suite 508
Phoenix, AZ 85006-2849
Phone (602) 839-3927

4200 E Camelback Rd
Phoenix, AZ 85018-2718

755 E McDowell Rd
Phoenix, AZ 85006-2506
Phone (602) 521-3086

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon CurrentSince Dec 1, 2018 Accepting new patients
Banner - University Physician Specialists LLC CurrentSince Oct 20, 2025 Accepting new patients
Banner - University Physician Specialists LLC CurrentSince Oct 20, 2025 Accepting new patients
Providence Health & Services - Oregon CurrentSince Oct 1, 2019 Accepting new patients
Providence Health & Services - Oregon CurrentSince Oct 3, 2018 Accepting new patients
Providence Health & Services Oregon CurrentSince Dec 1, 2018 Accepting new patients
Providence Health & Services Oregon CurrentSince Oct 3, 2018 Accepting new patients

Locations

1300 N 12th St
Ste 508
Phoenix, AZ 85006
Phone (602) 839-3927

4200 E Camelback Rd
Ste 202
Phoenix, AZ 85018
Phone (602) 229-2150

755 E McDowell Rd
Phoenix, AZ 85006
Phone (602) 271-5111

755 E McDowell Rd
Fl 4
Phoenix, AZ 85006
Phone (602) 521-3090

1111 Crater Lake Ave
Medford, OR 97504
Phone (541) 732-5250

1003 N Providence Dr
Ste 325
Newberg, OR 97132
Phone (503) 216-1661

1321 NE 99th Ave
Ste 200
Portland, OR 97220
Phone (503) 215-4250

4805 NE Glisan St
Portland, OR 97213
Phone (503) 215-1111

5050 NE Hoyt St
Ste 240
Portland, OR 97213
Phone (503) 215-6480

9205 SW Barnes Rd
Portland, OR 97225
Phone (503) 216-1234

9427 SW Barnes Rd
Ste 495
Portland, OR 97225
Phone (503) 216-0900

Organizations & group practices 9

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.

Hospital & facility affiliations 2

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": "1194393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763510400000",
    "number": "1720268618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 E MCDOWELL RD FL 4",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062506",
            "telephone_number": "602-521-3090",
            "fax_number": "602-521-3661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 E MCDOWELL RD FL 4",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062506",
            "telephone_number": "602-521-3090",
            "fax_number": "602-521-3661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "MITAL",
        "name_prefix": "Mrs.",
        "credential": "M.M.S,.P.A-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-07",
        "last_updated": "2025-11-19",
        "certification_date": "2025-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA189433",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "2740",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500756270",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANT COMMI",
            "identifier": "PA 17915",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.