BASIL SHAH (NPI# 1679684872) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679684872 |
| Entity Type | Individual |
| Full Name | BASIL SHAH |
| Credential | MD |
| Practice Address |
1340 Broad Ave Suite 450 Gulfport MS 39501-2404 |
| Mailing Address |
Po Box 1810 Gulfport MS 39502-1810 |
| Practice Telephone | 2288675006 |
| Practice Fax Number | 2288675079 |
| Mailing Telephone | 2288675006 |
| Mailing Fax Number | 2288675079 |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2014-07-31 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 174400000X | Specialist | 4301077845 | MI | Other Service Providers |
| N | 207T00000X | Neurological Surgery | 22774 | MS | Allopathic & Osteopathic Physicians |
| Y | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
22774 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | AL MEDICAID | 107229 | 01 |
| MS MEDICAID | 00188398 | 01 |
| Street Address |
1340 BROAD AVE SUITE 450 |
| City | GULFPORT |
| State | MS |
| Zip Code | 39501-2404 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912904590 | Jesse Pullen Penico | Internal Medicine | 1340 Broad Ave, Suite 300, Gulfport, MS 39501-2404 | 2005-06-28 |
| 1306409040 | Lissa Kelly Baber | Nurse Practitioner | 1340 Broad Ave, Gulfport, MS 39501-2404 | 2019-04-18 |
| 1780191577 | Tbd Acquisition II LLC | Social Worker | 1340 Broad Ave, Gulfport, MS 39501-2404 | 2018-01-03 |
| 1629517115 | Delana Mooney | Nurse Practitioner | 1340 Broad Ave, Suite 450, Gulfport, MS 39501-2404 | 2017-02-16 |
| 1396299590 | Charles Strange | Nurse Practitioner | 1340 Broad Ave, Suite 450, Gulfport, MS 39501-2404 | 2016-08-05 |
| 1942699988 | Beth Ann Gruzinskas | Nurse Practitioner | 1340 Broad Ave, Suite 270, Gulfport, MS 39501-2404 | 2015-01-14 |
| 1720477714 | Lacey Grimes Lichtenstein | Nurse Practitioner | 1340 Broad Ave, Gulfport, MS 39501-2404 | 2015-01-14 |
| 1669872974 | Jamie B Varnado | Social Worker | 1340 Broad Ave, Ste 410, Gulfport, MS 39501-2404 | 2014-08-25 |
| 1700121209 | Danielle Ronquille Lipski | Occupational Therapist | 1340 Broad Ave, Suite 270, Gulfport, MS 39501-2404 | 2012-12-10 |
| 1164767778 | Shannon Ann Church | Social Worker | 1340 Broad Ave, Ste 410, Gulfport, MS 39501-2404 | 2012-12-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598301632 | Daniel Edward Bloom | Physician Assistant | Naval Branch Health Clinic Gulfport, 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2019-11-25 |
| 1730721374 | Affinity Healthcare LLC | Non-emergency Medical Transport (VAN) | 1822 15th St, Suite 8, Gulfport, MS 39501 | 2019-10-15 |
| 1093361156 | Gulf Coast Companion Care, LLC | Home Health | 1314 Pass Road, Ste B, Gulfport, MS 39501 | 2019-08-14 |
| 1609420991 | Greg Meekin Ent | Otolaryngology | 1201 31st Avenue, Gulfport, MS 39501 | 2019-07-25 |
| 1225681216 | Murphy Chiropractic Gulfport, LLC | Clinic/Center | 2700 25th Ave., Gulfport, MS 39501 | 2019-07-19 |
| 1477022838 | Patriot Healthcare of Mississippi, LLC | Family Medicine | 1110 Broad Street, Suite 300, Gulfport, MS 39501 | 2018-11-15 |
| 1477003028 | Mindful Matters | Nurse Practitioner | 1613 23rd Avenue, Gulfport, MS 39501 | 2016-10-06 |
| 1902294093 | Tangular Barnes | Nurse Practitioner | Gulf Coast Mental Health Center, 1600 Broad Ave, Gulfport, MS 39501 | 2014-12-25 |
| 1487065355 | Huong Nguyen | Pharmacist | 2433 25th Avenue, Gulfport, MS 39501 | 2014-05-14 |
| 1770907412 | Matthew Coleman | Military Health Care Provider | Nbhc Naval Construction Battalion Center Gulfport, 5501 Marvin Shields Blvd, Gulfport, MS 39501 | 2014-02-18 |
| Find all providers in zip 39501 | ||||
| Taxonomy Code | 2085R0204X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Vascular & Interventional Radiology |
| A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043825540 | Gulf Coast Vascular Care, LLC | Radiology | 14219 Cook Rd, Biloxi, MS 39532-9719 | 2020-09-11 |
| 1093731895 | Vipin S Patel | Radiology | 1010 Lakeland Square Ext Ste B, Flowood, MS 39232-7607 | 2006-07-14 |
| 1376157099 | Kathryn Taylor Parvin | Radiology | 969 Lakeland Dr, Jackson, MS 39216-4699 | 2020-09-01 |
| 1780021170 | Ajinkya Shrinivas Desai | Radiology | 2500 N State St, Jackson, MS 39216-4500 | 2013-05-27 |
| 1023358132 | South Central Regional Medical Center | Radiology | 1410 Jefferson St, Laurel, MS 39440-4243 | 2013-02-26 |
| 1871838490 | Premier Interventional Radiology Clinic | Radiology | 891 Mississippi Dr, Tupelo, MS 38804-0934 | 2012-12-07 |
| 1770832461 | Flowood Vascular Access, LLC | Radiology | 1010 Lakeland Square Ext Ste B, Flowood, MS 39232-7607 | 2012-09-10 |
| 1194048231 | Delta Radiology Pllc | Radiology | 901 E Sunflower Rd, Cleveland, MS 38732-2833 | 2010-03-03 |
| 1083936231 | North Florida Radiological Institute Inc | Radiology | 1401 River Rd, Greenwood, MS 38930-4030 | 2010-02-15 |
| 1851620249 | Vascular Access Center of Bolivar County LLC | Radiology | 810 E Sunflower Rd, Suite 100b, Cleveland, MS 38732-2800 | 2009-12-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.