Physician Compare National (NPI:1710952825)

HEALTHCARE PROVIDER: DIPTI SHAH M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1710952825
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3870668205
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080820000375
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SHAH
	Individual professional last name
Provider First Name	DIPTI
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1983
	Individual professional's medical school graduation year
Primary Specialty	RHEUMATOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERNAL MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERNAL MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	15134 LEVAN RD
	Group Practice or individual's line 1 address
City	LIVONIA
	Group Practice or individual's city
State	MI
	Group Practice or individual's state
Zip Code	481545027
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	230002
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST MARY MERCY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	230020
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BEAUMONT HOSPITAL - DEARBORN
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	230156
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ST JOSEPH MERCY HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	230165
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	ST JOHN HOSPITAL AND MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y