NPIMap

Individual provider Active NPI

Maulin G Shah, D.O.

  • Family Medicine Physician
  • Dwight, IL
National Provider Identifier
1902149982
Registry record updated Feb 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036141076 Issued in IL
Practice address
107 Watters Dr
Dwight, IL 60420
Phone
(815) 584-4334
Fax
(815) 584-4364
NPI assigned
Mar 28, 2013
Last updated
Feb 25, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 25, 2019

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 036141076 IL Primary

Addresses

Primary practice location

107 Watters Dr
Dwight, IL 60420

Mailing address

107 Watters Dr
Dwight, IL 60420-1280
Phone (815) 584-4334

Other practice location 1

1912 Hayes Ave
Sandusky, OH 44870-4736
Phone (419) 557-7189

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20160719001154 IL Practitioner - Family Practice 5193018851 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Midwestern University, Chicago College of Osteopathic Med, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saint James HospitalGroup PAC ID 0648187252, 74 clinicians

Practice addresses (Care Compare)

107 Watters Dr
100 Osf Healthcare Medical Group Dwight
Dwight, IL 60420-1280
Phone (815) 584-3343

2500 W Reynolds St
Pontiac, IL 61764-9774
Phone (815) 842-2828

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Saint James Hospital CurrentSince Dec 1, 2022 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Saint James Hospital CurrentSince Dec 1, 2022 Accepting new patients
Osf Multi-Specialty Group CurrentSince Aug 14, 2016 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Saint James Hospital Past Accepting new patients

Locations

105 S John St
Dwight, IL 60420
Phone (815) 584-3343

107 Watters Dr
Dwight, IL 60420
Phone (815) 584-3343

107 Watters Dr
Ste 100
Dwight, IL 60420
Phone (815) 584-3343

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

2500 W Reynolds St
Pontiac, IL 61764
Phone (815) 842-2828

Organizations & group practices 6

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": "1364428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551052800000",
    "number": "1902149982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 WATTERS DR",
            "city": "DWIGHT",
            "state": "IL",
            "postal_code": "604201280",
            "telephone_number": "815-584-4334",
            "fax_number": "815-584-4364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 WATTERS DR",
            "city": "DWIGHT",
            "state": "IL",
            "postal_code": "60420",
            "telephone_number": "815-584-4334",
            "fax_number": "815-584-4364"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1912 Hayes Ave",
            "address_purpose": "LOCATION",
            "city": "Sandusky",
            "state": "OH",
            "postal_code": "448704736",
            "country_code": "US",
            "telephone_number": "419-557-7189",
            "fax_number": "419-557-7109",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAH",
        "first_name": "MAULIN",
        "middle_name": "G",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-03-28",
        "last_updated": "2019-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036141076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dwight, IL

Sources for this page

Verify at the official NPI Registry.