Individual provider Active NPI

Shivalli Dharmendra Rai, PA

  • Surgical Physician Assistant
  • Evansville, IN
National Provider Identifier
1861365876
Registry record updated Nov 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
10005089A Issued in IN
Practice address
901 Saint Marys Dr Ste 300
Evansville, IN 47714-0521
Phone
(812) 473-2642
NPI assigned
Sep 25, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 10005089A IN Primary

Addresses

Primary practice location

901 Saint Marys Dr Ste 300
Evansville, IN 47714-0521

Mailing address

901 Saint Marys Dr
Evansville, IN 47714-0520

Other practice location 1

901 Saint Marys Dr
Evansville, IN 47714-0520
Phone (812) 473-2642

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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 1

Enrollment IDStateProvider typePAC IDDetails
I20251125004685 IN Practitioner - Physician Assistant 0749772853 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Marys Medical Group LLCGroup PAC ID 1153493341, 230 clinicians

Practice addresses (Care Compare)

901 Saint Marys Dr
Suite 300
Evansville, IN 47714-0521
Phone (812) 473-2642

Hospital & facility affiliations

  • Ascension St Vincent Evansville Hospital, Evansville, IN, CCN 150100

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10005089AINMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St Mary'S Medical Group, LLC CurrentSince Nov 9, 2025 Accepting new patients
St Mary'S Medical Group, LLC CurrentSince Nov 9, 2025 Accepting new patients
St. Mary'S Health, Inc Past Accepting new patients

Locations

801 Saint Marys Dr
Ste 505E
Evansville, IN 47714
Phone (812) 491-3236

901 Saint Marys Dr
Ste 300
Evansville, IN 47714
Phone (812) 485-7725

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.

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": "1758758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763596800000",
    "number": "1861365876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 SAINT MARYS DR",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477140520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 SAINT MARYS DR STE 300",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477140521",
            "telephone_number": "812-473-2642"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "901 Saint Marys Dr",
            "address_purpose": "LOCATION",
            "city": "Evansville",
            "state": "IN",
            "postal_code": "477140520",
            "country_code": "US",
            "telephone_number": "812-473-2642",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAI",
        "first_name": "SHIVALLI",
        "middle_name": "DHARMENDRA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-09-25",
        "last_updated": "2025-11-20",
        "certification_date": "2025-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IN",
            "license": "10005089A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.