NPIMap

Individual provider Active NPI

Paul Y Shin, MD

  • Nephrology Physician
  • Lafayette, IN
National Provider Identifier
1821011594
Registry record updated Sep 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
01060949A Issued in IN
Practice address
114 Executive Dr
Suite a
Lafayette, IN 47905-4883
Phone
(765) 446-5185
Fax
(765) 446-5186
NPI assigned
Jul 25, 2006
Last updated
Sep 23, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 01060949A IN Primary

Addresses

Primary practice location

114 Executive Dr
Suite a
Lafayette, IN 47905-4883

Mailing address

PO Box 4699
Lafayette, IN 47903-4699
Phone (765) 449-2732

Other identifiers 1

IdentifierTypeStateIssuer
200800490MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address paulshin@idx.allscriptsdirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, IA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20051013000394 IN Practitioner - NephrologyPractitioner - Internal Medicine 7416848890 Reassigns benefits to 1 organization
I20260401002400 IA Practitioner - Nephrology 7416848890 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Genesis Health SystemGroup PAC ID 6103829338, 262 clinicians

Practice addresses (Care Compare)

1230 E Rusholme St
107 Mercyone Genesis Nephrology Care
Davenport, IA 52803-2400
Phone (563) 421-4280

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Physician Network CurrentSince Jan 1, 2012 Accepting new patients
Nephrology Associates of Northern Indiana, Inc Nephrology CurrentSince Nov 1, 2024 Accepting new patients
Franciscan Physician Network CurrentSince Jan 1, 2012 Accepting new patients
Nephrology Associates of Northern Illinois, LTD. Nephrology PastSince Jul 1, 2017 Accepting new patients

Locations

1704 Lafayette Rd
Ste 4
Crawfordsvlle, IN 47933
Phone (765) 364-3120

569 Tyler St
Gary, IN 46402
Phone (260) 885-3300

114 Executive Dr
Ste A
Lafayette, IN 47905
Phone (765) 446-5060

1701 S Creasy Ln
Lafayette, IN 47905
Phone (765) 502-4400

3875 Kensington Dr
Lafayette, IN 47905
Phone (765) 449-1555

90 W 86th Ave
Merrillville, IN 46410
Phone (219) 791-1555

150 W Washington St
Shelbyville, IN 46176
Phone (317) 392-3211

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: pshin41820@direct.davitaphysiciansolutions.com
  • Direct secure messaging: pshin5545@direct.franciscanalliance.org

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.

Hospital & facility affiliations 9

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": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727049600000",
    "number": "1821011594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4699",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479034699",
            "telephone_number": "765-449-2732",
            "fax_number": "765-449-1196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 EXECUTIVE DR",
            "address_2": "SUITE A",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479054883",
            "telephone_number": "765-446-5185",
            "fax_number": "765-446-5186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIN",
        "first_name": "PAUL",
        "middle_name": "Y",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IN",
            "license": "01060949A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200800490",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "paulshin@idx.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "114 Executive Dr",
            "address_2": "Suite A",
            "city": "Lafayette",
            "state": "IN",
            "country_code": "US",
            "postal_code": "479054883",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lafayette, IN

Sources for this page

Verify at the official NPI Registry.