Individual provider Active NPI

Anita Shivadas, MD

  • Internal Medicine Physician
  • Durham, NC
National Provider Identifier
1972559896
Registry record updated Dec 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35087481 Issued in OH
Practice address
5832 Fayetteville Rd
Suite 113
Durham, NC 27713-6290
Phone
(919) 544-6644
Fax
(919) 544-0934
NPI assigned
May 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2010

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35087481 OH Primary
Family Medicine Physician 207Q00000X 201001362 NC
Internal Medicine Physician 207R00000X 2010-01362 NC

Addresses

Primary practice location

5832 Fayetteville Rd
Suite 113
Durham, NC 27713-6290

Mailing address

5213 S Alston Ave
Durham, NC 27713-4430
Phone (919) 620-4917

Other identifiers 2

IdentifierTypeStateIssuer
166560OtherNCNC LICENSE
2654686MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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

Enrollment IDStateProvider typePAC IDDetails
I20110120000179 NC Practitioner - Internal Medicine 6204834872 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians

Practice addresses (Care Compare)

10211 Alm St
Suite 1100
Raleigh, NC 27617-8221
Phone (919) 620-5333

2701 Pickett Rd
Durham, NC 27705-5688
Phone (919) 419-9600

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
201001362NCMDFamily Medicine Physician
2010-01362NCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Duke University Affiliated Physicians, Inc. Family Medicine Current Accepting new patients
Duke University Affiliated Physicians, Inc. Family Medicine CurrentSince Feb 4, 2021 Accepting new patients
Duke University Affiliated Physicians, Inc. Family Medicine CurrentSince Feb 4, 2021 Accepting new patients

Locations

5832 Fayetteville Rd
Ste 113
Durham, NC 27713
Phone (919) 544-2049

5213 S Alston Ave
Durham, NC 27713
Phone (919) 620-4700

234 Crooked Creek Pkwy
Ste 200
Durham, NC 27713
Phone (919) 213-6631

5716 Fayetteville Rd
Durham, NC 27713
Phone (919) 572-1862

1901 Hillandale Rd
Ste D
Durham, NC 27705
Phone (919) 383-4355

7200 Creedmoor Rd
Ste 208
Raleigh, NC 27613
Phone (919) 327-1650

10211 Alm St
Ste 1100
Raleigh, NC 27617
Phone (919) 385-1160

Interoperability endpoints

  • Direct secure messaging: ashivadas3750@direct.medicine.duke.edu

Organizations & group practices 3

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.

Hospital & facility affiliations 9

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": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292371200000",
    "number": "1972559896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5213 S ALSTON AVE",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277134430",
            "telephone_number": "919-620-4917",
            "fax_number": "919-620-4921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5832 FAYETTEVILLE RD",
            "address_2": "SUITE 113",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277136290",
            "telephone_number": "919-544-6644",
            "fax_number": "919-544-0934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIVADAS",
        "first_name": "ANITA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-25",
        "last_updated": "2010-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35087481",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "201001362",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2010-01362",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC LICENSE",
            "identifier": "166560",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2654686",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

Verify at the official NPI Registry.