Individual provider Active NPI

Siddhi Shah, P.T.

  • Physical Therapist
  • San Jose, CA
National Provider Identifier
1760044911
Registry record updated Feb 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
302001 Issued in CA
Practice address
6489 Camden Ave Ste 109
San Jose, CA 95120-2850
Phone
(408) 268-0600
Fax
(415) 570-2236
NPI assigned
Jul 8, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5501019131 MI
Physical Therapist 225100000X P20527 NC
Physical Therapist 225100000X 302001 CA Primary

Addresses

Primary practice location

6489 Camden Ave Ste 109
San Jose, CA 95120-2850

Mailing address

6489 Camden Ave Ste 109
San Jose, CA 95120-2850
Phone (408) 268-0600

Other practice location 1

1317 N Brightleaf Blvd Ste A
Smithfield, NC 27577-7267
Phone (919) 300-5040

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190806001159 MI Practitioner - Physical Therapist in Private Practice 1052648607 Reassigns benefits to 1 organization
I20221111002293 CA Practitioner - Physical Therapist in Private Practice 1052648607 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Almaden Physical Therapy IncGroup PAC ID 3870936644, 3 clinicians

Practice addresses (Care Compare)

6489 Camden Ave
Suite 109
San Jose, CA 95120-2850
Phone (470) 779-5576

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
302001CAMDPhysical Therapist
5501019131MIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Almaden Physical Therapy Inc Physical Therapist CurrentSince Dec 5, 2023 Accepting new patients
Ally Physical Therapy LLC Physical Therapist CurrentSince Jun 25, 2019 Accepting new patients
Campbell'S Premier Physical Therapy, Inc Physical Therapist CurrentSince Sep 26, 2022 Accepting new patients
Almaden Physical Therapy PastSince Dec 5, 2023 Accepting new patients

Locations

163 E Hamilton Ave
Campbell, CA 95008
Phone (408) 866-5567

6489 Camden Ave
Ste 109
San Jose, CA 95120
Phone (408) 268-0600

32858 5 Mile Rd
Livonia, MI 48154
Phone (734) 525-3000

Organizations & group practices 4

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": "1562544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709078400000",
    "number": "1760044911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6489 CAMDEN AVE STE 109",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951202850",
            "telephone_number": "408-268-0600",
            "fax_number": "415-570-2236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6489 CAMDEN AVE STE 109",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951202850",
            "telephone_number": "408-268-0600",
            "fax_number": "415-570-2236"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1317 N Brightleaf Blvd Ste A",
            "address_purpose": "LOCATION",
            "city": "Smithfield",
            "state": "NC",
            "postal_code": "275777267",
            "country_code": "US",
            "telephone_number": "919-300-5040",
            "fax_number": "919-438-0893",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAH",
        "first_name": "SIDDHI",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-08",
        "last_updated": "2024-02-28",
        "certification_date": "2024-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501019131",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P20527",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "302001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.