Active NPI
Shobha Mahadevan, M.D.
- Internal Medicine Physician
- Dekalb, IL
National Provider Identifier
1821082231
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- Practice address
- Health Services
Northern Illinois University, Wirtz Drive
Dekalb, IL 60115 - Phone
- (815) 753-1311
- Fax
- (815) 753-5906
- NPI assigned
- Aug 31, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | IL | Primary |
Addresses
Primary practice location
Health Services
Northern Illinois University, Wirtz Drive
Dekalb, IL 60115
Mailing address
Health Services
Northern Illinois University, Wirtz Drive
Dekalb, IL 60115
Phone (815) 753-1311
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036-096889-1 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180829003850 | IL | Order and Referring Only - Internal Medicine | 8325097306 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-096889 | IL | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1821082231",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "HEALTH SERVICES",
"address_2": "NORTHERN ILLINOIS UNIVERSITY, WIRTZ DRIVE",
"city": "DEKALB",
"state": "IL",
"postal_code": "60115",
"telephone_number": "815-753-1311",
"fax_number": "815-753-5906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "HEALTH SERVICES",
"address_2": "NORTHERN ILLINOIS UNIVERSITY, WIRTZ DRIVE",
"city": "DEKALB",
"state": "IL",
"postal_code": "60115",
"telephone_number": "815-753-1311",
"fax_number": "815-753-5906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAHADEVAN",
"first_name": "SHOBHA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-31",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036-096889-1",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dekalb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.