NPIMap

Individual provider Active NPI

Nimesh Kesharichard Shah, MD

  • Nephrology Physician
  • Hollis, NY
National Provider Identifier
1871674051
Registry record updated Apr 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
232109 Issued in NY
Practice address
20507 Hillside Ave Ste 12
Hollis, NY 11423
Phone
(718) 464-6700
Fax
(718) 464-8100
NPI assigned
Oct 17, 2006
Last updated
Apr 9, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 232109 NY
Nephrology Physician 207RN0300X 232109 NY Primary

Addresses

Primary practice location

20507 Hillside Ave Ste 12
Hollis, NY 11423

Mailing address

20507 Hillside Ave Ste 12
Hollis, NY 11423-2220
Phone (718) 464-6700

Other practice location 1

8268 164th St
Jamaica, NY 11432-1121
Phone (718) 883-3225

Other practice location 2

8268 164th St
Jamaica, NY 11432-1121
Phone (718) 883-3225

Other identifiers 1

IdentifierTypeStateIssuer
00246075MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070926000024 NY Practitioner - NephrologyPractitioner - Internal Medicine 2062506702 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

20507 Hillside Ave
Suite 12
Hollis, NY 11423-2220
Phone (347) 891-3345

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
22.15 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
73.83

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Good Samaritan Hospital Medical Center Current Accepting new patients
Good Samaritan Hospital Medical CurrentSince Jan 1, 2013 Accepting new patients
N K Shah Medical PC Internal Medicine CurrentSince May 13, 2013 Accepting new patients

Locations

10828 68th Dr
Forest Hills, NY 11375
Phone (718) 261-9245

3 N Main St
Fl 2
Freeport, NY 11520
Phone (718) 464-6700

20507 Hillside Ave
Ste 12
Hollis, NY 11423
Phone (718) 464-6700

300 Community Dr
Manhasset, NY 11030

27005 76th Ave
North New Hyde Pk, NY 11040

1000 Montauk Hwy
West Islip, NY 11795
Phone (516) 705-2689

Networks

  • Healthfirst Medicare Network H3359

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617926400000",
    "number": "1871674051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20507 HILLSIDE AVE STE 12",
            "city": "HOLLIS",
            "state": "NY",
            "postal_code": "114232220",
            "telephone_number": "718-464-6700",
            "fax_number": "718-334-3432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20507 HILLSIDE AVE STE 12",
            "city": "HOLLIS",
            "state": "NY",
            "postal_code": "11423",
            "telephone_number": "718-464-6700",
            "fax_number": "718-464-8100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8268 164th St",
            "address_purpose": "LOCATION",
            "city": "Jamaica",
            "state": "NY",
            "postal_code": "114321121",
            "country_code": "US",
            "telephone_number": "718-883-3225",
            "fax_number": "718-883-6193",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8268 164th St",
            "address_purpose": "LOCATION",
            "city": "Jamaica",
            "state": "NY",
            "postal_code": "114321121",
            "country_code": "US",
            "telephone_number": "718-883-3225",
            "fax_number": "718-883-6193",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAH",
        "first_name": "NIMESH",
        "middle_name": "KESHARICHARD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2021-04-09",
        "certification_date": "2021-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "232109",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NY",
            "license": "232109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00246075",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollis, NY

Sources for this page

Verify at the official NPI Registry.