| Nikhil Shah, PA-C | |
|
563 Brendible Street, Metlakatla, AK 99926 | |
| (907) 886-4742 | |
| (907) 886-5831 |
| Full Name | Nikhil Shah |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant |
| Experience | 7 Years |
| Location | 563 Brendible Street, Metlakatla, Alaska |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912541145 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 201084 (Alaska) | Primary |
| 363A00000X | Physician Assistant | 50.006202RX (Ohio) | Secondary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Ketchikan Medical Center | Ketchikan, AK | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Southeast Alaska Regional Health Consortium | 1456265362 | 373 |
| Metlakatla Indian Community | 5890691315 | 19 |
| Entity Name | Southeast Alaska Regional Health Consortium |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1376758037 PECOS PAC ID: 1456265362 Enrollment ID: O20031114000631 |
| Entity Name | Metlakatla Indian Community |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1740294081 PECOS PAC ID: 5890691315 Enrollment ID: O20031208000361 |
| Mailing Address | Practice Location Address |
|---|---|
| Nikhil Shah, PA-C 7735 Ohio St, Mentor, OH 44060-4850 Ph: (440) 251-3340 | Nikhil Shah, PA-C 563 Brendible Street, Metlakatla, AK 99926 Ph: (907) 886-4742 |
Ms. Jody J Leisholmn, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 563 Brendible St., Metlakatla, AK 99926 Phone: 907-886-4741 |