Individual provider Active NPI

Paul Cyrus Shahidi, MD

  • Family Medicine Physician
  • Madisonville, KY
National Provider Identifier
1871937508
Registry record updated Dec 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
48394 Issued in KY
Practice address
200 Clinic Dr
Madisonville, KY 42431-1661
Phone
(270) 825-6680
Fax
(270) 825-7266
NPI assigned
Apr 24, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 48394 KY Primary

Addresses

Primary practice location

200 Clinic Dr
Madisonville, KY 42431-1661

Mailing address

2700 Stanley Gault Pkwy Ste 129
Louisville, KY 40223-5176
Phone (502) 253-4900

Other identifiers 1

IdentifierTypeStateIssuer
7100309290MedicaidKY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pshahidi8728@bhkydirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20141222002647 KY Practitioner - Family Practice 2668795709 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

200 Clinic Dr
FL 1
Madisonville, KY 42431-1661
Phone (270) 825-6680

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Health Deaconess Medical Group Inc Family Medicine CurrentSince Sep 1, 2021 Accepting new patients
Southeastern Physician Services PC CurrentSince Sep 1, 2016 Accepting new patients
Baptist Health Deaconess Medical Group Inc Family Medicine CurrentSince Sep 1, 2021 Accepting new patients
Baptist Health Madisonville Inc Family Medicine Past Accepting new patients

Locations

310 S Limestone
Lexington, KY 40508
Phone (606) 252-6612

200 Clinic Dr
Fl 1
Madisonville, KY 42431
Phone (270) 825-6680

200 Clinic Dr
Madisonville, KY 42431
Phone (270) 821-8874

800 Hospital Dr
Fl 2
Madisonville, KY 42431
Phone (270) 326-3900

900 Hospital Dr
Madisonville, KY 42431
Phone (270) 326-3900

360 Amsden Ave
Versailles, KY 40383
Phone (606) 873-3111

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.

Hospital & facility affiliations 2

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": "1366761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606867200000",
    "number": "1871937508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 STANLEY GAULT PKWY STE 129",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402235176",
            "telephone_number": "502-253-4900",
            "fax_number": "502-489-5750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 CLINIC DR",
            "city": "MADISONVILLE",
            "state": "KY",
            "postal_code": "424311661",
            "telephone_number": "270-825-6680",
            "fax_number": "270-825-7266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAHIDI",
        "first_name": "PAUL",
        "middle_name": "CYRUS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-24",
        "last_updated": "2020-12-02",
        "certification_date": "2020-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "48394",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100309290",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pshahidi8728@bhkydirect.com",
            "affiliation": "N",
            "address_1": "200 Clinic Dr",
            "city": "Madisonville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "424311661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Madisonville, KY

Sources for this page

Verify at the official NPI Registry.