NIRAJ SHAH
NPI 1326300831
Family Medicine in Mount Pleasant, WI

Q: What is Niraj Shah's NPI number?

The NPI number for Niraj Shah is 1326300831. It was assigned to this individual provider in the NPPES registry on June 11, 2012.

Q: What is Niraj Shah's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for Niraj Shah was last updated on August 5, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 11, 2012PECOS EnrolledAccepts Medicare Assignment

8400 WASHINGTON AVE, MOUNT PLEASANT, WI 53406(262) 884-4000 Get Directions Write a Review

NPPES record last updated: August 5, 2024. Verified against the NPPES registry weekly; last sync: October 04, 2026.

Record update history: Aug 5, 2024, Dec 15, 2021, Feb 26, 2016 (3 updates tracked since 2016).

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About Niraj Shah NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NIRAJ SHAH (NPI 1326300831) is an individual family medicine provider in Mount Pleasant, Wisconsin, licensed in Wisconsin (64153) and active in the NPI registry since June 2012. He is enrolled in Medicare PECOS, is affiliated with Aurora Medical Center Kenosha, and maintains a secondary practice location in Aurora.

NPPES Registry Identity

NPI1326300831

Entity TypeIndividualMale

Primary Taxonomy207Q00000X

Provider Legal NameNIRAJ SHAH

Location Address8400 WASHINGTON AVEMount Pleasant, WI 53406-3735

Mailing AddressPo Box 735044Chicago, IL 60673-5044 · (800) 326-2250

Phone(262) 884-4000

Sole ProprietorNo

Medical School CMSOtherGraduated 2012

Enumeration DateJune 11, 2012

Last NPPES UpdateAugust 5, 20243 updates tracked since enumeration

NPPES CertifiedAugust 5, 2024

✔ NPI 1326300831 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Licenses✔ Licensed in WI · 64153✔ Licensed in IL · 125.061309

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

8400 WASHINGTON AVE, Mount Pleasant, WI 53406

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Secondary Practice Location 1

Location 12020 Ogden Ave, Suite 325Aurora, IL 60504-5894 · Phone (630) 978-4850 · Fax (630) 978-6865

Other Identifiers 1

Medicaid100046771WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Aspirus Health Plan, CareSource (Common Ground Healthcare) and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Niraj Shah is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8820302938

PECOS Enrollment IDI20150803002853

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 11

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

345 services162 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

139 services108 patients

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439

An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.

135 services135 patients

Administration of influenza virus vaccine G0008

The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.

54 services51 patients

Influenza vaccine split virus, preservative free 90662

The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.

50 services48 patients

Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment G0402

An Initial Preventive Physical Examination, also known as a "Welcome to Medicare" visit, is a one-time, face-to-face visit during your first 12 months of Medicare enrollment. It includes a review of your health, as well as education and counseling about preventive services and further screenings.

20 services20 patients

Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report 93000

An electrocardiogram (ECG) is a non-invasive test that records your heart's electrical activity. Using 12 leads attached to your body, it captures data to help identify heart conditions. A doctor interprets the results and provides a report.

19 services18 patients

Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215

This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.

17 services16 patients

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

14 services14 patients

Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and G0180

This is a service where a doctor or authorized practitioner certifies that you require Medicare-covered home health services. They will communicate with the home health agency and review reports on your health status to ensure you receive appropriate care. This does not involve an in-person visit.

14 services13 patients

Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit G0438

An annual wellness visit is a yearly appointment with your doctor to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's an opportunity to discuss your health status and goals and get a plan tailored for you.

11 services11 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Aurora Medical Center Kenosha

Acute Care Hospitals · Kenosha, WI

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number520189

Location10400 75th StKenosha, WI 53142 · Kenosha County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 53406 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$82.92 typical visit price

range $53.90 – $163.24

Typical copayment $20.73 (range $13.47 – $40.81)

Most-billed visit code 99203

Established Patient

$95.41 typical visit price

range $17.40 – $133.76

Typical copayment $23.85 (range $4.35 – $33.44)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims 14

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253

DME-Other DME · category DE017N

7 suppliers31 claims98 services$5.76 avg. paid by Medicare

Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each A4351

DME-Orthotic Devices · category DF008N

2 suppliers11 claims660 services$1.76 avg. paid by Medicare

Tubing with integrated heating element for use with positive airway pressure device A4604

DME-Other DME · category DE001N

4 suppliers14 claims14 services$33.13 avg. paid by Medicare

Full face mask used with positive airway pressure device, each A7030

DME-Other DME · category DE001N

3 suppliers16 claims16 services$79.30 avg. paid by Medicare

Face mask interface, replacement for full face mask, each A7031

DME-Other DME · category DE001N

3 suppliers15 claims36 services$30.74 avg. paid by Medicare

Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap A7034

DME-Other DME · category DE001N

2 suppliers13 claims13 services$59.30 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. NANDITA BATCHRA MD

Otolaryngology