Active NPI
Shae Mortazavi, QBHP
- Case Manager/Care Coordinator
- Russellville, AR
National Provider Identifier
1831779008
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- License
- 0000
- Practice address
- 104 Lock and Dam Rd
Russellville, AR 72802-9725 - Phone
- (479) 747-5222
- NPI assigned
- Apr 12, 2021
- 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 |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | 0000 | AR | Primary |
Addresses
Primary practice location
104 Lock and Dam Rd
Russellville, AR 72802-9725
Mailing address
104 Lock and Dam Rd
Russellville, AR 72802-9725
Phone (479) 747-5222
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PENDING | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0000 | AR | MD | Case Manager/Care Coordinator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618185600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1760400000000",
"number": "1831779008",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 LOCK AND DAM RD",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "728029725",
"telephone_number": "479-747-5222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 LOCK AND DAM RD",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "728029725",
"telephone_number": "479-747-5222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORTAZAVI",
"first_name": "SHAE",
"credential": "QBHP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-12",
"last_updated": "2025-10-14",
"certification_date": "2025-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "AR",
"license": "0000",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PENDING",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Russellville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.