Individual provider Active NPI

Shivali Kanal, PA-C

  • Physician Assistant
  • Lexington, KY
National Provider Identifier
1861009482
Registry record updated Dec 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA3464 Issued in KY
Practice address
1720 Nicholasville Rd Ste 500
Lexington, KY 40503-1487
Phone
(859) 278-1114
Fax
(859) 277-0541
NPI assigned
Sep 28, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA3464 KY Primary
Physician Assistant 363A00000X 085009409 IL

Addresses

Primary practice location

1720 Nicholasville Rd Ste 500
Lexington, KY 40503-1487

Mailing address

1221 S Broadway
Lexington, KY 40504-2701
Phone (859) 258-6200

Other practice location 1

230 Fountain Ct Ste 230
Lexington, KY 40509-1897
Phone (859) 977-5335

Other practice location 2

1012 Ival James Blvd Ste B
Richmond, KY 40475-8278
Phone (859) 624-3615

Other practice location 3

200 Bevins Ln Ste A
Georgetown, KY 40324-8532
Phone (502) 863-9007

Other identifiers 1

IdentifierTypeStateIssuer
7101021470MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, KY2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20201102000129 TN Practitioner - Physician Assistant 5294145322 Reassigns benefits to 1 organization
I20241025003577 KY Practitioner - Physician Assistant 5294145322 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New Lexington Clinic PSCGroup PAC ID 3476457532, 329 clinicians
H2 Rehabilitation Services of Kentucky, LLCGroup PAC ID 5799682688, 187 clinicians

Practice addresses (Care Compare)

1012 Ival James Blvd B
Richmond, KY 40475-8174
Phone (859) 624-3615

1207 S Broadway
Lexington, KY 40504-2701
Phone (859) 258-4000

1221 S Broadway
Lexington, KY 40504-2701
Phone (859) 258-4000

1225 S Broadway
Suite 201
Lexington, KY 40504-2701
Phone (859) 258-4568

193 Glades Rd
Berea, KY 40403-2261
Phone (859) 956-1055

230 Fountain CT
Suite 230
Lexington, KY 40509-1897
Phone (859) 977-5335

Hospital & facility affiliations

  • Baptist Health Lexington Hospital, Lexington, KY, CCN 180103

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA3464KYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Humphreys County Community Health Services Inc CurrentSince Sep 24, 2020 Accepting new patients
Humphreys County Community Health Services, Inc. CurrentSince Sep 24, 2020 Accepting new patients
New Lexington Clinic, PSC CurrentSince Oct 7, 2024 Accepting new patients
New Lexington Clinic PSC CurrentSince Oct 7, 2024 Accepting new patients

Locations

200 Bevins Ln
Ste A
Georgetown, KY 40324
Phone (502) 863-0722

1720 Nicholasville Rd
Ste 500
Lexington, KY 40503
Phone (859) 278-1114

1221 S Broadway
Lexington, KY 40504
Phone (859) 258-4181

230 Fountain Ct
Ste 230
Lexington, KY 40509
Phone (859) 977-5335

1012 Ival James Blvd
Ste B
Richmond, KY 40475
Phone (859) 624-3615

451 Highway 13 S
Waverly, TN 37185
Phone (931) 296-0211

Interoperability endpoints

  • Direct secure messaging: shivali.kanal.1@13059.direct.athenahealth.com
  • Direct secure messaging: skanal@advent.emadirect.md

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 1

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": "1601251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734048000000",
    "number": "1861009482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 S BROADWAY",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405042701",
            "telephone_number": "859-258-6200",
            "fax_number": "859-258-6203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 NICHOLASVILLE RD STE 500",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405031487",
            "telephone_number": "859-278-1114",
            "fax_number": "859-277-0541"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "230 Fountain Ct Ste 230",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "KY",
            "postal_code": "405091897",
            "country_code": "US",
            "telephone_number": "859-977-5335",
            "fax_number": "859-977-5340",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1012 Ival James Blvd Ste B",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "KY",
            "postal_code": "404758278",
            "country_code": "US",
            "telephone_number": "859-624-3615",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 Bevins Ln Ste A",
            "address_purpose": "LOCATION",
            "city": "Georgetown",
            "state": "KY",
            "postal_code": "403248532",
            "country_code": "US",
            "telephone_number": "502-863-9007",
            "fax_number": "502-863-9008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KANAL",
        "first_name": "SHIVALI",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-28",
        "last_updated": "2024-12-13",
        "certification_date": "2024-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA3464",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085009409",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7101021470",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, KY

Sources for this page

Verify at the official NPI Registry.