Shivali P Desai, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2400 Issued in NC

Practice address

2015 Randolph Rd Ste 108
Charlotte, NC 28207-1200

Phone

(704) 334-2020

Fax

(833) 231-6851

NPI assigned

Jul 23, 2012

Sex

Female

Sole proprietor

No

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 SC, NC2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Optometry

Education

University of Missouri St Louis - School of Optometry, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northside Vision, LLCGroup PAC ID 2860523701, 2 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

95.15 of 100Reported as group

Quality

100

Improvement activities

40

Cost

83.84

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Northside Vision, LLC

  • Optometrist
  • Boiling Springs, SC
  • NPI 1184948150
  Medicare reassignment Care Compare group NPD
• East Coast Optometric, Inc

  dba H. Rubin Vision Center

  • Optometrist
  • Columbia, SC
  • NPI 1790862597
  NPD (past)

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

{
    "created_epoch": "1343001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608508800000",
    "number": "1780939041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4101 CAMPUS RIDGE RD",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281055077",
            "telephone_number": "704-234-1930",
            "fax_number": "833-233-6851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 RANDOLPH RD STE 108",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071200",
            "telephone_number": "704-334-2020",
            "fax_number": "833-231-6851"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8816 University East Dr Ste C",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282134109",
            "country_code": "US",
            "telephone_number": "704-547-8730",
            "fax_number": "833-231-6851",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4101 Campus Ridge Rd",
            "address_purpose": "LOCATION",
            "city": "Matthews",
            "state": "NC",
            "postal_code": "281055077",
            "country_code": "US",
            "telephone_number": "704-234-1930",
            "fax_number": "833-233-6851",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "630 Comfort Ln Ste E",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "NC",
            "postal_code": "281126493",
            "country_code": "US",
            "telephone_number": "704-289-5455",
            "fax_number": "704-291-2207",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DESAI",
        "first_name": "SHIVALI",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-23",
        "last_updated": "2020-12-21",
        "certification_date": "2020-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1721",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "2400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mayur Pareshkumar Desai, CPP
• Neelam Samit Desai
• Niraj Suresh Desai, M.D.
• Nita Ajit Desai, MD
• Payal Chandarana Desai, MD
• Shivani Kirit Desai, DDS, MS
• Sima Ajit Desai, MD
• Urvi Gautam Desai, MD
• Raynald Leon Desameau, DMD
• Janet Labayo Desamero, PA

• Optometrist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Optometrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2020; 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.