Individual provider Active NPI

Shideh Shafie, M.D.

  • Emergency Medicine Physician
  • Providence, RI
National Provider Identifier
1871796243
Registry record updated Dec 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD15651 Issued in RI
Practice address
593 Eddy St
Providence, RI 02903-4923
Phone
(401) 519-1604
Fax
(401) 272-0538
NPI assigned
Jun 6, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 14, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 263660-1 NY
Emergency Medicine Physician 207P00000X MD15651 RI Primary

Addresses

Primary practice location

593 Eddy St
Providence, RI 02903-4923

Mailing address

PO Box 9484
Providence, RI 02940-9484
Phone (401) 854-2513

Other practice location 1

355 Prairie Ave
Providence, RI 02905-1928
Phone (401) 415-9000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sshafie60264@HCNetwork.direct-ci.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170505000591 RI Practitioner - Emergency Medicine 9931355401 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

31 Atwood St
Providence, RI 02909-3410
Phone (401) 444-0590

355 Prairie Ave
Providence, RI 02905-1928
Phone (401) 444-0570

375 Allens Ave
Providence, RI 02905-5010
Phone (401) 444-0400

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
263660-1NYMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lifespan Physician Group, Inc. CurrentSince Dec 1, 2020 Accepting new patients
The Providence Community Health Centers, Inc CurrentSince Aug 15, 2022 Accepting new patients
Lifespan Physician Group, Inc. Emergency Medicine CurrentSince Dec 1, 2020 Accepting new patients
Maimonides Medical Center Current Accepting new patients

Locations

4802 10th Ave
Brooklyn, NY 11219
Phone (718) 283-8724

185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050

164 Summit Ave
Providence, RI 02906
Phone (401) 793-2104

375 Allens Ave
Providence, RI 02905
Phone (401) 444-0400

593 Eddy St
Providence, RI 02903

31 Atwood St
Providence, RI 02909
Phone (401) 444-0590

Interoperability endpoints

  • Direct secure messaging: shidehshafie@mai.allscriptsdirect.net
  • Direct secure messaging: sshafie60264@hcnetwork.direct-ci.com

Organizations & group practices 4

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702512000000",
    "number": "1871796243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9484",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029409484",
            "telephone_number": "401-854-2513",
            "fax_number": "401-854-2519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "401-519-1604",
            "fax_number": "401-272-0538"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "355 Prairie Ave",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029051928",
            "country_code": "US",
            "telephone_number": "401-415-9000",
            "fax_number": "401-396-2065",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAFIE",
        "first_name": "SHIDEH",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-06",
        "last_updated": "2023-12-14",
        "certification_date": "2023-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "263660-1",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "RI",
            "license": "MD15651",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sshafie60264@HCNetwork.direct-ci.com",
            "affiliation": "N",
            "address_1": "355 Prairie Ave",
            "city": "Providence",
            "state": "RI",
            "country_code": "US",
            "postal_code": "029051928",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.