Evan T. Shack, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

25MA07398800 Issued in NJ

Practice address

100 Carnie Blvd
Suite B-5
Voorhees, NJ 08043-4512

Phone

(856) 751-0123

Fax

(856) 751-0535

NPI assigned

Sep 2, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 9

Medicare fee-for-service enrollment

Enrolled in NJ

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

Specialty

Diagnostic Radiology

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

South Jersey Radiology Associates P aGroup PAC ID 9133115587, 202 clinicians

Radiology Associates of Burlington County P aGroup PAC ID 7012954381, 153 clinicians

Larchmont Imaging AssociatesGroup PAC ID 5193762433, 54 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• West Jersey Hospital Hospital, Voorhees, NJ, CCN 310022
• Virtua Mount Holly Hospital Hospital, Mount Holly, NJ, CCN 310057
• Virtua Our Lady of Lourdes Hospital Hospital, Camden, NJ, CCN 310029
• Virtua Willingboro Hospital Hospital, Willingboro, NJ, CCN 310061
• Jefferson Stratford Hospital Hospital, Stratford, NJ, CCN 310086

Merit-based Incentive Payment System (MIPS)

Final score

78.75 of 100Reported as group

Quality

75

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

83.17 of 100Reported as group

Quality

75

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

78.75 of 100Reported as group

Quality

75

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Larchmont Imaging Associates

  • Diagnostic Radiology Physician
  • Mount Laurel, NJ
  • NPI 1710932603
  Medicare reassignment Care Compare group NPD
• Radiology Associates of Burlington County P a

  • Diagnostic Radiology Physician
  • Mount Holly, NJ
  • NPI 1255385183
  Medicare reassignment Care Compare group NPD
• South Jersey Radiology Associates P a

  • Diagnostic Radiology Physician
  • Voorhees, NJ
  • NPI 1477551653
  Medicare reassignment Care Compare group NPD
• Diagnostic Imaging Inc

  • Diagnostic Radiology Physician
  • Philadelphia, PA
  • NPI 1093786410
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Kennedy University Hospital Inc.

  • General Acute Care Hospital
  • Stratford, NJ
  • NPI 1386746592
  Care Compare affiliation
• Virtua - Memorial Hospital Burlington County, Inc.

  dba Virtua Mount Holly Hospital

  • General Acute Care Hospital
  • Mount Holly, NJ
  • NPI 1134125016
  Care Compare affiliation
• Virtua - West Jersey Health System, Inc.

  • General Acute Care Hospital
  • Voorhees, NJ
  • NPI 1528064409
  Care Compare affiliation
• Virtua Our Lady of Lourdes Hospital Inc

  dba Virtua Our Lady of Lourdes Hospital

  • General Acute Care Hospital
  • Camden, NJ
  • NPI 1235134024
  Care Compare affiliation
• Virtua Willingboro Hospital Inc

  dba Virtua Health & Wellness Center

  • General Acute Care Hospital
  • Willingboro, NJ
  • NPI 1053316844
  Care Compare affiliation

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

{
    "created_epoch": "1125619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348704000000",
    "number": "1932193166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1710",
            "address_2": "SOUTH JERSEY RADIOLOGY ASSOCIATES, PA",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080437710",
            "telephone_number": "856-770-0300",
            "fax_number": "856-770-0395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CARNIE BLVD",
            "address_2": "SUITE B-5",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080434512",
            "telephone_number": "856-751-0123",
            "fax_number": "856-751-0535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACK",
        "first_name": "EVAN",
        "middle_name": "T.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-02",
        "last_updated": "2012-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NJ",
            "license": "25MA07398800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HORIZON NJ HEALTH",
            "identifier": "1163572",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "2117877000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "2201310",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK PA BLUE SHIELD",
            "identifier": "SH1433148",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "300131187",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD HEALTH",
            "identifier": "A3738029",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMIER BLUE",
            "identifier": "SH1433148",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8839301",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2978264",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Keneil Shah
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• Diagnostic Radiology Physician in Voorhees, NJ
• Providers in Voorhees, NJ by specialty
• Diagnostic Radiology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.