DR. SHANTHA KUMAR M.D.
NPI 1396768958
Internal Medicine - Cardiovascular Disease in Apache Junction, AZ

Active since July 25, 2006PECOS EnrolledAccepts Medicare Assignment
75/100
CMS Quality Rating
99 S GOLD DR, APACHE JUNCTION, AZ 85120(480) 962-0101(480) 962-0202 Get Directions Write a Review

NPPES record last updated: April 12, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Apr 12, 2024, Dec 3, 2015 (2 updates tracked since 2015).

About Dr. Shantha Kumar M.d. NPPES

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

DR. SHANTHA KUMAR M.D. (NPI 1396768958) is an individual cardiovascular disease provider in Apache Junction, Arizona, licensed in Arizona (23951) and active in the NPI registry since July 2006. He is enrolled in Medicare PECOS, maintains a secondary practice location in Mesa, and is a graduate of Other (1987).

NPPES Registry Identity

NPI1396768958
Entity TypeIndividualMale
Primary Taxonomy207RC0000X
Provider Legal NameDR. SHANTHA KUMARCredential: M.D.
Location Address99 S GOLD DRApache Junction, AZ 85120-5035
Mailing Address99 S Gold DrApache Junction, AZ 85120-5030 · (480) 962-0101 · Fax (480) 962-0202
Fax(480) 962-0202
Sole ProprietorYes
Medical School CMSOtherGraduated 1987
Enumeration DateJuly 25, 2006
Last NPPES UpdateApril 12, 20242 updates tracked since enumeration
NPPES CertifiedApril 12, 2024
NPI 1396768958 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyInternal Medicine · Cardiovascular DiseaseAllopathic & Osteopathic Physicians
Taxonomy Code207RC0000X
License Licensed in AZ · 23951
Definition
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.
Also ListedSpecialistTaxonomy 174400000X · License 23951 (AZ)
99 S GOLD DR, Apache Junction, AZ 85120

Secondary Practice Location 1

Location 17615 E Baseline Rd Ste 101Mesa, AZ 85209-2000 · Phone (480) 962-0101

Other Identifiers 2

Other376592AZ · Ahcccs
OtherAZ 0742840AZ · Bc/bs

Accepted 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

Dr. Shantha Kumar M.d. 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 ID1557259082
PECOS Enrollment IDI20040426001534
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 66

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.

Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes 99349
An established patient home visit is a medical appointment conducted at your home, typically lasting around 40 minutes. This service is ideal for patients who may find it difficult to travel to a healthcare facility. During this visit, a healthcare professional will evaluate your health status, manage your care, and answer any health-related questions you may have.
745 services142 patients
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.
616 services316 patients
Management using the results of remote vital sign monitoring per calendar month, each additional 20 minutes 99458
This service involves analyzing your vital signs, like heart rate and blood pressure, remotely collected over a month. Each additional 20 minutes spent on management refers to extra time spent reviewing, interpreting your data, and planning your care. It's a critical part of ensuring your wellbeing.
572 services70 patients
Injection, regadenoson, 0.1 mg J2785
Regadenoson injection, 0.1 mg, is a medication used to help visualize the heart during a stress test. It works by increasing blood flow in the arteries of the heart. It's injected into a vein and is generally well-tolerated.
528 services132 patients
Management using the results of remote vital sign monitoring per calendar month, first 20 minutes 99457
This service involves reviewing and managing your health data, which is remotely monitored and collected. Your vital signs like heart rate and blood pressure are tracked regularly throughout the month. The first 20 minutes of this data analysis per month is included in this service.
433 services84 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.
418 services314 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 85120 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
$127.71 typical visit price
range $55.44 – $168.60
Typical copayment $31.92 (range $13.86 – $42.15)
Most-billed visit code 99204
Established Patient
$69.24 typical visit price
range $17.72 – $137.41
Typical copayment $17.31 (range $4.43 – $34.35)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

75/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice

Reported Quality Measures

Coronary Artery Disease (CAD): Antiplatelet Therapy
Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease (CAD) seen within a 12 month period who were prescribed aspirin or clopidogrel
89%339 patients4/55-star benchmark: 100%
Documentation of Current Medications in the Medical Record
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter.
99%1,850 patients4/55-star benchmark: 100%
e-Prescribing
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
81%498 patients4/55-star benchmark: 100%
Patient-Specific Education
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
5%438 patients1/55-star benchmark: 100%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous…
93%1,027 patients4/55-star benchmark: 100%
Provide Patient Access
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…
64%438 patients3/55-star benchmark: 100%
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Other Providers at the Same Location NPPES

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

Dietitian, Registered
99 S GOLD DR, SUITE 6
APACHE JUNCTION, AZ 85120

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shantha Kumar's NPI number?

The NPI number for Shantha Kumar is 1396768958. It was assigned to this individual provider in the NPPES registry on July 25, 2006.

Where is Shantha Kumar located?

Shantha Kumar practices at 99 S Gold Dr, Apache Junction, AZ 85120. The listed phone number is (480) 962-0101.

What is Shantha Kumar's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Cardiovascular Disease, with taxonomy code 207RC0000X.

Is Shantha Kumar enrolled in Medicare?

Yes. Shantha Kumar is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Shantha Kumar accept?

Health plans from Ambetter from Arizona Complete Health, Blue Cross Blue Shield of Arizona, Oscar Health Plan, Inc. and UnitedHealthcare list Shantha Kumar as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Shantha Kumar was last updated on April 12, 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.