NPIMap

Individual provider Active NPI

Kushal Deepak Shah, M.D.

  • Family Medicine Physician
  • Naperville, IL
National Provider Identifier
1932633849
Registry record updated Nov 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036152184 Issued in IL
Practice address
101 E 75TH St Ste 105
Naperville, IL 60565-1411
Phone
(630) 933-1700
Fax
(630) 933-6240
NPI assigned
Apr 18, 2017
Last updated
Nov 2, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 036152184 IL Primary

Addresses

Primary practice location

101 E 75TH St Ste 105
Naperville, IL 60565-1411

Mailing address

101 E 75TH St Ste 105
Naperville, IL 60565-1411
Phone (630) 933-1700

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
I20200701003327 IL Practitioner - Family Practice 2668746199 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Central Dupage Physician GroupGroup PAC ID 5890696231, 1,087 clinicians

Practice addresses (Care Compare)

101 E 75TH St
Suite 1000
Naperville, IL 60565-1410
Phone (630) 225-2663

1800 N Main St
Wheaton, IL 60187-3112
Phone (630) 933-4800

660 N Westmoreland Rd
302 Lake Forest OBGYN
Lake Forest, IL 60045-1673
Phone (312) 926-6146

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
95.63 of 100Reported as apm
Quality
88.47
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036152184ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group Family Medicine CurrentSince Jul 20, 2020 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Sep 1, 2021 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Sep 1, 2021 Accepting new patients
Central Dupage Physician Group CurrentSince Jul 20, 2020 Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

515 Valley View Dr
Ste 201
Moline, IL 61265
Phone (312) 695-0870

101 E 75th St
Ste 105
Naperville, IL 60565
Phone (630) 933-1700

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1492473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604275200000",
    "number": "1932633849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E 75TH ST STE 105",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605651411",
            "telephone_number": "630-933-1700",
            "fax_number": "630-933-6240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E 75TH ST STE 105",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605651411",
            "telephone_number": "630-933-1700",
            "fax_number": "630-933-6240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "KUSHAL",
        "middle_name": "DEEPAK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-18",
        "last_updated": "2020-11-02",
        "certification_date": "2020-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036152184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Naperville, IL

Sources for this page

Verify at the official NPI Registry.