Individual provider Active NPI

Shrena Patel, MD

  • Pediatrics Physician
  • Salt Lake City, UT
National Provider Identifier
1811164031
Registry record updated Apr 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
6246246-1205 Issued in UT
Practice address
295 Chipeta Way
Salt Lake City, UT 84108-1287
Phone
(801) 581-7052
NPI assigned
May 15, 2008
Last updated
Apr 10, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 6246246-1205 UT Primary
Neonatal-Perinatal Medicine Physician 2080N0001X 066881 GA

Addresses

Primary practice location

295 Chipeta Way
Salt Lake City, UT 84108-1287

Mailing address

875 Donner Way Apt 1004
Salt Lake City, UT 84108-4100

Other identifiers 6

IdentifierTypeStateIssuer
12001050OtherGAAETNA
0833146OtherGACIGNA
650683OtherGAWELLCARE
01470758OtherGAAMERIGROUP
3409438OtherGAUNITED HEALTHCARE
003116750AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20120109000783 GA Practitioner - Pediatric Medicine 4789720335 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
6246246-1205UTMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Longstreet Clinic PC CurrentSince Dec 1, 2011 Accepting new patients
The Longstreet Clinic, PC Pediatrics CurrentSince Dec 1, 2011 Accepting new patients
Northeast Georgia Community Physicians LLC CurrentSince Feb 1, 2026 Accepting new patients
Swedish Health Services Past Accepting new patients
Northeast Georgia Medical Center, Inc. Past Accepting new patients
Overlake Medical Center & Clinics Past Accepting new patients

Locations

725 Jesse Jewell Pkwy SE
Gainesville, GA 30501
Phone (770) 297-2200

743 Spring St NE
Gainesville, GA 30501
Phone (770) 219-5915

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1210809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334016000000",
    "number": "1811164031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "875 DONNER WAY APT 1004",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841084100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "295 CHIPETA WAY",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081287",
            "telephone_number": "801-581-7052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "SHRENA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-15",
        "last_updated": "2012-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "6246246-1205",
            "primary": true
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "GA",
            "license": "066881",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "12001050",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "0833146",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "650683",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "01470758",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "3409438",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003116750A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.