Active NPI
Kshama P Shah, M.D.
- Neonatal-Perinatal Medicine Physician
- Evanston, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neonatal-Perinatal Medicine Physician
- License
- 036140108
- Practice address
- 2650 Ridge Ave
Evanston, IL 60201-1700 - Phone
- (847) 570-2033
- NPI assigned
- Jun 14, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 036.140108 | IL | |
| Neonatal-Perinatal Medicine Physician | 2080N0001X | 036140108 | IL | Primary |
Addresses
Primary practice location
2650 Ridge Ave
Evanston, IL 60201-1700
Mailing address
2650 Ridge Ave
Evanston, IL 60201-1700
Phone (847) 570-2033
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA, IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children's Hospital Los Angeles Medical Group, Inc. | Pediatrics | Current | Accepting new patients |
| Endeavor Health Medical Group | Current | Accepting new patients | |
| Endeavor Health Medical Group | Pediatrics | Current | Accepting new patients |
Locations
3701 Wilshire Blvd
Ste 600
Los Angeles, CA 90010
Phone (323) 361-3550
4650 W Sunset Blvd
Los Angeles, CA 90027
Phone (323) 361-2122
9532 Eagle Way
Chicago, IL 60678
2650 Ridge Ave
#1223
Evanston, IL 60201
Phone (847) 982-3172
2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206
2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222
Interoperability endpoints
- kshah347037@direct.myadvocateaurora.org
Organizations & group practices 3
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.
-
dba NorthShore University HealthSystem Faculty Practice Associates
- Emergency Medicine Physician
- Evanston, IL
- NPI 1497701882
Pediatrics
-
- Multi-Specialty Clinic/Center
- Los Angeles, CA
- NPI 1265530653
Pediatrics
-
dba NorthShore Anesthesia Group
- Anesthesiology Physician
- Evanston, IL
- NPI 1265695944
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623110400000",
"number": "1841552957",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2650 RIDGE AVE",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602011700",
"telephone_number": "847-570-2033"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2650 RIDGE AVE",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602011700",
"telephone_number": "847-570-2033"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAH",
"first_name": "KSHAMA",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-14",
"last_updated": "2021-06-08",
"certification_date": "2021-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036.140108",
"primary": false
},
{
"code": "2080N0001X",
"taxonomy_group": "",
"desc": "Pediatrics, Neonatal-Perinatal Medicine",
"state": "IL",
"license": "036140108",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Evanston, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2021; 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.