NPIMap

Individual provider Active NPI

Bobby Ajay Shah, M.D.

  • Diagnostic Radiology Physician
  • Port St Lucie, FL
National Provider Identifier
1871534925
Registry record updated Jan 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
01056041A Issued in IN
Practice address
3275 SW Darwin Blvd
Port St Lucie, FL 34953-3317
Phone
(800) 437-2672
NPI assigned
Jun 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X 01056041A IN
Diagnostic Radiology Physician 2085R0202X 01056041A IN Primary

Addresses

Primary practice location

3275 SW Darwin Blvd
Port St Lucie, FL 34953-3317

Mailing address

825 E Lincolnway
Valparaiso, IN 46383-5803
Phone (219) 464-4891

Other practice location 1

825 E Lincolnway
Valparaiso, IN 46383-5803
Phone (219) 464-4891

Other identifiers 2

IdentifierTypeStateIssuer
200382730MedicaidIN
300135676OtherINRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, FL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090609000199 AZ Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 4880783414 Reassigns benefits to 2 organizations
I20230131003008 FL Practitioner - Diagnostic Radiology 4880783414

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic RadiologyAlso: Interventional Radiology
Education
University of Kansas School of Med (KC/Wich/Sal), 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pinnacle Healthcare LLCGroup PAC ID 3870939614, 22 clinicians

Practice addresses (Care Compare)

101 Civic Ctr LN
Lake Havasu City, AZ 86403-5607
Phone (928) 855-8151

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01056041AINMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pinnacle Healthcare LLC Diagnostic Radiology CurrentSince Mar 1, 2024 Accepting new patients
Florida United Radiology LC Diagnostic Radiology Current Accepting new patients
Lakeside Orthopedic Institute LLC Diagnostic Radiology CurrentSince Jun 3, 2021 Accepting new patients
Lakeside Orthopedic Institute LLC CurrentSince Jun 3, 2021 Accepting new patients
Sonoran Radiology LTD Diagnostic Radiology CurrentSince Mar 1, 2021 Accepting new patients
Radiologic Associates of Northwest Indiana, PC Diagnostic Radiology Past Accepting new patients
Dunes Optical, LLC Past Accepting new patients
Kurt O Doggwiler MD PHD LTD Diagnostic Radiology PastSince Sep 1, 2010 Accepting new patients
Medical Group Surgery Center LLC Past Accepting new patients

Locations

2050 W Southern Ave
Apache Junction, AZ 85120
Phone (480) 237-3200

5330 S Highway 95
Fort Mohave, AZ 86426
Phone (928) 788-2273

5555 W Thunderbird Rd
Glendale, AZ 85306
Phone (602) 588-5555

101 Civic Center Ln
Lk Havasu Cty, AZ 86403
Phone (928) 453-0150

25 Riviera Blvd
Lk Havasu Cty, AZ 86403
Phone (928) 505-7246

6750 E Baywood Ave
Mesa, AZ 85206
Phone (480) 854-5000

1201 S Alma School Rd
Ste 14500
Mesa, AZ 85210
Phone (602) 698-7715

1625 N Campbell Ave
Tucson, AZ 85719

13333 Northwest Fwy
Ste 540
Houston, TX 77040
Phone (281) 962-3608

Interoperability endpoints

  • Direct secure messaging: hum9685@yourcarecommunity.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Havasu Regional Medical CenterLake Havasu City, AZ, CCN 030069 Hospital Corporate Director Jan 25, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673827200000",
    "number": "1871534925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 E LINCOLNWAY",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463835803",
            "telephone_number": "219-464-4891",
            "fax_number": "219-464-1873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3275 SW DARWIN BLVD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349533317",
            "telephone_number": "800-437-2672"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "825 E Lincolnway",
            "address_purpose": "LOCATION",
            "city": "Valparaiso",
            "state": "IN",
            "postal_code": "463835803",
            "country_code": "US",
            "telephone_number": "219-464-4891",
            "fax_number": "219-464-1873",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAH",
        "first_name": "BOBBY",
        "middle_name": "AJAY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2023-01-16",
        "certification_date": "2023-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "IN",
            "license": "01056041A",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "01056041A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200382730",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "300135676",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port St Lucie, FL

Sources for this page

Verify at the official NPI Registry.