NPIMap

Individual provider Active NPI

Mobin Shah, MD

  • Hospitalist Physician
  • Fayetteville, GA
National Provider Identifier
1932319613
Registry record updated Mar 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
064068 Issued in GA
Practice address
1255 Highway 54 W
Fayetteville, GA 30214-4526
Phone
(770) 719-5609
Fax
(770) 719-5629
NPI assigned
May 23, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 25, 2019

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 64068 GA
Internal Medicine Physician 207R00000X 64068 GA
Hospitalist Physician 208M00000X 64068 GA
Hospitalist Physician 208M00000X 064068 GA Primary

Addresses

Primary practice location

1255 Highway 54 W
Fayetteville, GA 30214-4526

Mailing address

352 Langshire Dr
McDonough, GA 30253-8055
Phone (256) 457-4618

Other identifiers 3

IdentifierTypeStateIssuer
102317534MedicaidPA
953138OtherMDCAREFIRST MD BCBS
2109320OtherPAHIGHMARK BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20110112000649 GA Practitioner - Internal MedicinePractitioner - Family Practice 3870649981 Reassigns benefits to 4 organizations
Practice locations: McDonough, GA

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Family Practice
Education
Other, 1997
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

352 Langshire Dr
McDonough, GA 30253-8055
Phone (256) 457-4618

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
56.12 of 100Reported as individual
Quality
65.6
Improvement activities
0
Cost
71.06

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
064068GAMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Piedmont Healthcare Inc CurrentSince Aug 1, 2015 Accepting new patients
Apex Healthcare Hospitalist CurrentSince Mar 9, 2026 Accepting new patients
Mobin Shah Inc Family Medicine CurrentSince Nov 1, 2017 Accepting new patients
Southern Grace Hospice and Palliative Care Family Medicine CurrentSince May 1, 2014 Accepting new patients
Aneri Health Care, LLC Internal Medicine PastSince Mar 9, 2026 Accepting new patients
Hospital Physician Services - Southeast Professional Corporation Hospitalist Past Accepting new patients

Locations

35 Collier Rd NW
Ste 635
Atlanta, GA 30309
Phone (404) 367-3000

1984 Peachtree Rd NW
Ste 205
Atlanta, GA 30309

80 Candler Rd
McDonough, GA 30253
Phone (678) 432-8811

2101 Newnan Crossing Blvd E
Newnan, GA 30265
Phone (678) 552-6200

11 Upper Riverdale Rd SW
Riverdale, GA 30274
Phone (770) 897-7277

1133 Eagles Landing Pkwy
Stockbridge, GA 30281
Phone (678) 604-1000

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Southern Grace Hospice and Palliative CareMcDonough, GA, CCN 111750 Hospice Contracted Managing Employee May 1, 2014

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553472000000",
    "number": "1932319613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "352 LANGSHIRE DR",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302538055",
            "telephone_number": "256-457-4618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1255 HIGHWAY 54 W",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144526",
            "telephone_number": "770-719-5609",
            "fax_number": "770-719-5629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "MOBIN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-23",
        "last_updated": "2019-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "64068",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "64068",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "GA",
            "license": "64068",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "GA",
            "license": "064068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102317534",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST MD BCBS",
            "identifier": "953138",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "2109320",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, GA

Sources for this page

Verify at the official NPI Registry.