NPIMap

Individual provider Active NPI

Shalva V Kakabadze, MD

  • Family Medicine Physician
  • Reynoldsville, PA
National Provider Identifier
1962465427
Registry record updated Jun 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD442814 Issued in PA
Practice address
5 N 3Rd St
Reynoldsville, PA 15851-0907
Phone
(814) 653-8222
Fax
(814) 653-9305
NPI assigned
Apr 7, 2006
Last updated
Jun 10, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35079515 OH
Family Medicine Physician 207Q00000X MD442814 PA Primary

Addresses

Primary practice location

5 N 3Rd St
Reynoldsville, PA 15851-0907

Mailing address

PO Box 447
Du Bois, PA 15801-0447
Phone (814) 653-8222

Other identifiers 1

IdentifierTypeStateIssuer
2257776MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20110630000490 PA Practitioner - Family Practice 9739103821 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians
Dubois Regional Medical CenterGroup PAC ID 5890689715, shared by 39 NPIs, 424 clinicians

Practice addresses (Care Compare)

2000 Westinghouse Dr
Cranberry Township, PA 16066-5238

5 N 3Rd St
Reynoldsville, PA 15851-0907
Phone (814) 653-8222

635 Maple Ave
Dubois, PA 15801-2376
Phone (814) 371-4320

635 Maple Ave
Du Bois, PA 15801-2383
Phone (814) 375-6212

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.6 of 100Reported as group
Promoting interoperability
96
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue23
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35079515OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dubois Regional Medical Group, PC Family Medicine CurrentSince Aug 29, 2016 Accepting new patients
Dubois Regional Medical Center Family Medicine CurrentSince Jul 1, 2011 Accepting new patients
Dubois Regional Medical Group, PC Family Medicine Current Accepting new patients
Dubois Regional Medical Center Family Medicine CurrentSince Jul 7, 2011 Accepting new patients
Dubois Regional Medical Center Family Medicine CurrentSince Aug 24, 2011 Accepting new patients
Osu Family Practice Services Family Medicine Current Accepting new patients
Dubois Regional Medical Center Family Medicine Past Accepting new patients

Locations

543 Taylor Ave
Fl 2
Columbus, OH 43203
Phone (614) 293-2700

7094 E Main St
Reynoldsburg, OH 43068
Phone (614) 237-1067

100 Hospital Ave
Dubois, PA 15801
Phone (814) 375-2040

100 Hospital Ave
Ofc
Dubois, PA 15801

145 Hospital Ave
Ste 102
Dubois, PA 15801
Phone (814) 375-6510

5 N 3rd St
Reynoldsville, PA 15851
Phone (814) 653-8222

5 N 3rd St
#P
Reynoldsville, PA 15851
Phone (814) 653-8222

Interoperability endpoints

  • Direct secure messaging: skakbadze@1285.direct.myezyaccess.com

Organizations & group practices 7

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 36

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

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1144368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307664000000",
    "number": "1962465427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 447",
            "city": "DU BOIS",
            "state": "PA",
            "postal_code": "158010447",
            "telephone_number": "814-653-8222",
            "fax_number": "814-653-9305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 N 3RD ST",
            "city": "REYNOLDSVILLE",
            "state": "PA",
            "postal_code": "158510907",
            "telephone_number": "814-653-8222",
            "fax_number": "814-653-9305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAKABADZE",
        "first_name": "SHALVA",
        "middle_name": "V",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-07",
        "last_updated": "2011-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35079515",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD442814",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2257776",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Reynoldsville, PA

Sources for this page

Verify at the official NPI Registry.