TUSHAR N. SHAH, MD
FACC · FAHA · FHFSA · FASE · FACP
241 Summerford Place, Dayton, OH 45458
tushar.shah@mac.com
(937) 371-1677
NPI 1326004896
Verified verified by Tushar
Review staged for review
Needed certificate needed
Action Dashboard
ACTION ITEMS (2 active)
| Item | Deadline | Status |
|---|---|---|
| Oregon MB self-report (Case 26-0100) | No deadline — waiting on Board | Waiting — status check emailed to Cooney 4/9/2026. OMB public record confirms no board actions on file (verified 4/9/2026). |
| Tdap booster — 10-year cycle expired | June 2025 | Scheduled — CVS Pharmacy #03477, 400 Miamisburg-Centerville Rd, Centerville OH 45459 — 5/18/2026 12:00 PM ET (combined visit: Tdap + Shingles dose 1 + Pneumonia) |
UPCOMING EXPIRATIONS — DECISIONS NEEDED
| License | Expires | Days Left | 60-Day Alert |
|---|---|---|---|
| North Carolina 9600057 | 7/26/2026 | 108 | May 27 |
| Georgia 89480 | 7/31/2026 | 113 | June 1 |
| Illinois 036158334 | 7/31/2026 | 113 | June 1 |
| Virginia 0101272971 | 7/31/2026 | 113 | June 1 |
Renewal decisions deferred per Q7 — collaborative state-by-state review needed before 60-day window opens (late May).
INCOMPLETE IN THIS DOCUMENT
| Section | What's Needed |
|---|---|
| CME Compliance | Core CME/MOC transcript and current root CME certificates are now linked below; historical year folders are not summarized here. |
| Active license proof gaps | Need current sendable certificate PDFs or online-verification exports for Georgia, Illinois, Kentucky, and Virginia. |
Demographic Information
Full Name: Tushar Nandlal Shah
Suffix: M.D., FACC, FAHA, FHFSA, FACP, FASE
Date of Birth: 7/26/1966
Sex: Male
Marital Status: Married
Place of Birth: Kisumu, Kenya
Citizenship: USA
Languages: English, Gujarati
Other Names Used: No
Address: 241 Summerford Place, Dayton, OH 45458E-Mail: tushar.shah@mac.com
Dates of Residence: 3/10/2006 - Present
Mobile: (937) 371-1677Home: (937) 885-4322
Spouse (Emergency Contact)
Name: Bina Praful Shah
DOB: 9/12/1968
Mobile: (937) 241-2064
Family Members
| Relation | Name | DOB | Status |
|---|---|---|---|
| Mother | Indira Nandlal Shah | 12/7/1937 | Deceased 8/6/2010, Age 72 |
| Father | Nandlal Chimanlal Shah | 7/3/1933 | Deceased 11/1/2019, Age 86 |
| Brother | Sandip Nandlal Shah | 9/30/1963 | Alive, Age 62 |
| Daughter | Monica Shah | 12/20/1996 | Alive |
| Son | Anand Shah | 10/4/1999 | Alive |
| Son | Milan Shah | 7/20/2002 | Alive |
| Daughter | Anjali Shah | 10/29/2008 | Alive |
Personal Identification
Driver's License
License Number: TG001014
Date of Birth: 07/26/1966
Full Name: Tushar Nandlal Shah
State: Ohio
Expiration: 07/26/2032 ACTIVE
Issued: 08/26/2024
Class: D
Restriction: B - Corrective Lenses
Eyes / Sex: BRO / M
Height / Weight: 5-04 / 145
DD-REF: D11954939
Compliance Number: 5772VV27664900
Address: 241 Summerford Pl, Dayton, OH 45458
Directives: Organ donor; health care POA; life-sustaining equipment
Social Security
SSN: 079-48-2410
Citizenship
Country: United States of America
Date of Naturalization: 5/2/1977
Certificate Number: A-807052
Passport
Passport No: A06541059
Type: P (Regular)
Expiration: 6/9/2032 ACTIVE
Issue Date: 6/10/2022
Issuing Authority: United States Department of State
Place of Birth: Kenya
Prior Passport
Passport No: 486116393
Issue Date: 12/11/2011
Expiration: 12/11/2021 EXPIRED
Prior Residences
View All Prior Residences (16 addresses)
| Location | Address | Dates |
|---|---|---|
| Louisville, KY | The Vue, 537 S. 3rd St., Apt 1109, Louisville, KY 40202 | 11/1/2019 - 8/24/2020 |
| Danville, PA | 1002 Bloom Road, Apt 101, Danville, PA 17821 | 4/16/2018 - 8/18/2018 |
| Danville, PA (temp) | Pine Barn Inn, 43 Pine Barn Place, Danville, PA 17821 | 3/18/2018 - 4/16/2018 |
| Lexington, KY | 201 Price Road, Apt 223, Lexington, KY 40511 | 7/1/2015 - 6/30/2017 |
| Evansville, IN | 6417 Highcroft Drive, Evansville, IN 47715 | (dates not specified) |
| Austin, TX | 406 Wallis Drive, Austin, TX 78746 | 10/20/2011 - 6/20/2012 |
| Dayton, OH (temp) | Villas on Far Hills, 4629 Far Hills Ave #1A, Dayton, OH 45429 | 12/1/2005 - 3/10/2006 |
| Tulsa, OK | 4947 East 105th Street, Tulsa, OK 74137 | 7/9/2004 - 9/16/2005 |
| Dallas, TX | 5112 Tennington Park, Dallas, TX 75287 | 7/1/2000 - 7/9/2004 |
| Desoto, TX | 712 Creek Tree Lane, Desoto, TX 75115 | 7/1/1997 - 7/1/2000 |
| Durham, NC | 3317 Appling Way, Durham, NC 27703 | 7/1/1994 - 7/1/1997 |
| Chapel Hill, NC | 512 Dogwood Drive, Chapel Hill, NC 27516 | (med school) |
| Chapel Hill, NC | 105 Timber Hollow Ct, Apt 329, Chapel Hill, NC 27514 | (med school) |
| Charlotte, NC | 5501 Pepperdine Drive, Charlotte, NC 28226 | (childhood) |
| Asheville, NC | 99 Sleepy Hollow Dr., Asheville, NC 28805 | (childhood) |
| Yonkers, NY | Palisade Avenue, Yonkers, NY | (childhood) |
Immunizations
⚠ Positive QuantiFERON-TB Gold Plus (9/22/2021)
Latent TB infection confirmed after years of negative screening. Chest X-ray PA & Lateral obtained 9/27/2021 (on file).
Annual symptom screening required for credentialing. No active TB disease identified.
TB Screening History
| Date | Test | Result | Lab / Location | Notes | Documents |
|---|---|---|---|---|---|
| 9/22/2021 | QuantiFERON-TB Gold Plus | POSITIVE | LabCorp, Dayton, OH | First positive result. Chest X-ray ordered. | Proof |
| 9/27/2021 | Chest X-ray PA & Lateral | No active disease | Kettering Hospital, Kettering, OH | Follow-up to positive QFT. | Proof |
| 10/2/2019 | PPD (tuberculin skin test) | Negative (0 mm) | Whitesburg ARH, Cardiology | Brand: Aplisol, Lot #3a7633. Read 10/4/2019. | Proof |
| 11/14/2016 | QuantiFERON TB Gold | Negative | U of Iowa Employee Health / Mayo Clinic Labs | Nil 0.07, TB Ag-Nil 0.32, Mitogen >10 IU/mL | Proof |
| 7/2/2015 | QuantiFERON TB Gold | Negative | UK Employee Health, Lexington, KY | Nil 0.03, Ag 0.20, Mitogen >10 IU/mL. Read by Floyd Kackley, RN. | Proof |
| 1/19/2015 | TB test | Negative | Highlands Regional Medical Center, Eastern Kentucky | Proof | |
| 10/3/2012 | TB test | Negative | UC Health Employee Health / Drake Center | Proof | |
| 2/12/2010 | TB Skin Test Attestation | Negative | Miami Valley Hospital | Proof | |
| 4/21/2009 | QuantiFERON | Negative | CompuNet Clinical Labs, Dayton, OH | Ordered by Dr. Ahmad Saleem, Primed Lincoln Pk Cardiology | Proof |
| 7/25/2005 | TB test | Negative | Ozarks Medical Center / Ozark WORKS | Proof | |
| 4/28/2004 | PPD (tuberculin skin test) | Negative | South Austin Internal Medicine | Proof |
Immunity Verified by Titers
Original vaccination dates unknown. Immunity documented by serologic testing.
| Disease | Test / Method | Result | Date | Lab | Documents |
|---|---|---|---|---|---|
| Hepatitis B | Hepatitis B Surface Antibody (HBsAb) | Positive (Immune) | 4/8/2004 | Clinical Pathology Laboratories, Austin, TX | Proof |
| Rubella | Rubella IgG | 1.97 IU/mL (Immune) | 6/15/2015 | LabCorp, Prestonsburg, KY | Proof |
| Rubeola (Measles) | Rubeola IgG | 274.0 AU/mL (Positive) | 6/15/2015 | LabCorp, Prestonsburg, KY | Proof |
| Mumps | Mumps IgG | 29.5 AU/mL (Positive) | 6/15/2015 | LabCorp, Prestonsburg, KY | Proof |
| Historical Mumps / Rubella Titers | Mumps IgG; Rubella antibody screen | Positive / Immune | 4/28/2004 | Clinical Pathology Laboratories, Austin, TX | Proof |
| Varicella | Positive history (verified) | Compliant | 7/8/2015 | UK Health Compliance verification | Certificate needed |
Vaccinations
Tdap (Tetanus, Diphtheria, Pertussis)
⏲ SCHEDULED - 10-year booster appointment on 5/18/2026 12:00 PM ET at CVS Pharmacy #03477, 400 Miamisburg-Centerville Rd, Centerville OH 45459. Combined visit with Shingles dose 1 + Pneumonia. Proof PDF will be added after the appointment.
Last Administered: 6/15/2015
Location: Highlands Health System
Lot #: AB67KY
10-Year Booster Due: June 2025 — scheduled 5/18/2026 (CVS Centerville)
Pending Appointment
COVID-19 Vaccination
| Dose | Date | Location | Manufacturer/Lot | Documents |
|---|---|---|---|---|
| 1st Dose | 1/8/2021 | Columbus Public Health | Moderna / 039K20-2A | Proof |
| 2nd Dose | 2/9/2021 | Columbus Public Health | Moderna / 028L20A | Proof |
| Booster | 10/22/2022 | Mercy Regional Medical Center, Durango, CO | Pfizer / FF8841 | Proof Needed |
| 2025-2026 Updated | 9/18/2025 | CVS Pharmacy #06139 | Comirnaty (Pfizer) | Proof Needed |
Influenza - Most Recent
Season: 2025-2026
Product: Flucelvax (cell-based)
Date: 9/18/2025
Location: CVS Pharmacy #06139
Next Due: Fall 2026
Proof Needed
Not Yet Documented
| Vaccine | Notes | Documents |
|---|---|---|
| Shingrix (Shingles) | Recommended for adults 50+. Age 59 - should confirm status. | Proof Needed |
| Pneumococcal (PCV20 or PPSV23) | Recommended for adults 65+ or with diabetes. Should confirm status. | Proof Needed |
Compliance Verification Record (UK 7/8/2015)
University of Kentucky Health Compliance Form verified on 7/8/2015 by Floyd Kackley, RN, confirmed compliance for:
Hepatitis B (titer), MMR (titers), Varicella (positive history), Tdap (6/15/2015), TB (QuantiFERON negative 7/2/2015).
This employer compliance attestation is not a clinical certificate; it is retained here for credentialing context only.
Record
Education & Training
| Program | Institution | Dates | Degree/Specialty | Notes | Documents |
|---|---|---|---|---|---|
| High School | NC School of Science and Mathematics, Durham, NC | 9/1982 - 5/1984 | HS Diploma | Registrar: Linsey Morrison, (919) 416-2977, morrisonl@ncssm.edu | Certificate Needed |
| Undergraduate | University of Pennsylvania, Philadelphia, PA | 8/24/1984 - 5/14/1988 | BA Biochemistry | Registrar: (215) 898-6636, registrar@srfs.upenn.edu | certificate |
| Medical School | UNC School of Medicine, Chapel Hill, NC | 9/24/1989 - 5/15/1994 | MD with Highest Honors | Full scholarship, Distinguished Medical Scholars Program. 5 years due to 1 year research. Registrar: (919) 962-8335 | certificate |
| Internship | Duke University Medical Center, Durham, NC | 7/1/1994 - 6/30/1995 | Internal Medicine & Pediatrics | PD: Ralph Corey, MD / Michael Frank, MD. Current PD: Jane Vy Trinh, MD. Verification: Jen Averitt, (919) 681-2383 |
certificate |
| Residency | Duke University Medical Center, Durham, NC | 7/1/1995 - 6/30/1997 | Internal Medicine | PD: Ralph Corey, MD. Current PD: Aimee Zaas, MD. Verification: Jen Averitt, (919) 681-2383 |
certificate |
| Fellowship | Baylor University Medical Center, Dallas, TX | 7/1/1997 - 6/30/2000 | Cardiovascular Disease | PD: Peter J. Wells, MD. Current PD: Michael N. Sills, MD. Verification: Shawn Guy-Pitts, (214) 820-2234 |
certificate |
| Fellowship | Heart Center of Indiana, St. Vincent, Indianapolis, IN | 10/1/2005 - 3/31/2006 | Adv. CV Imaging (CT/MRI) | PD: Ronald Razmi, MD. Verification: Shannon Mollenkopf, (317) 583-6044 |
certificate |
| Fellowship | University of Kentucky Medical Center, Lexington, KY | 7/2015 - 7/2016 | Advanced HF & Transplant | PD: Maya Guglin, MD. Current PD: Paul Anaya, MD. Verification: Sara Baird, (859) 323-8040 |
certificate |
USMLE Examinations
USMLE ID: 3-432-291-7
| Step | Date | Attempts | Result | Documents |
|---|---|---|---|---|
| USMLE Step 1 | June 1994 | 1 | Pass | Score |
| USMLE Step 2 | March 1993 | 1 | Pass | Score |
| USMLE Step 3 | June 1995 | 1 | Pass | Score |
| Combined report | ||||
Board Certifications
Updated from MOC system as of April 9, 2026. ABIM ID: 195890.
Verified verified by Tushar
Review staged for review
Needed certificate needed
Proof MOC evidence pending upload
| Certification | Board | Cert Date(s) | Status | Certificate |
|---|---|---|---|---|
| Internal Medicine | ABIM | 9/1/2000 | Active, maintaining certification (MOC) Proof | certificate |
| Cardiovascular Disease | ABIM | 11/2001, 11/2011, 11/2021 | Active, maintaining certification (MOC) Proof | Certificate needed Historical Cardiology certificates exist on file; no single combined certificate PDF is linked here yet. |
| Advanced Heart Failure and Transplant | ABIM | 11/1/2010 | Lapsed | certificate |
| Adult Echocardiography | NBE | 6/13/1999, 6/13/2009 | Active, maintaining certification (MOC) Proof | certificate |
| Nuclear Cardiology | CBNC | 10/20/2002 | Lapsed | certificate |
| Cardiovascular CT | CBCCT | 9/22/2008 | Lapsed | certificate |
| Clinical Hypertension | ASH | 6/1/2011 | Lapsed | certificate |
| NBME | NBME | 12/1/1995 | Permanent | certificate |
ABIM Certification Agency Contact
ABIM: 510 Walnut St., Suite 1700, Philadelphia, PA 19106. Phone: (800) 441-2246. Fax: (215) 446-3590
Honors, Awards & Society Fellowships
| Honor | Date | Organization | Documents |
|---|---|---|---|
| Fellow, Heart Failure Society of America (FHFSA) | 7/2021 | HFSA, Rockville, MD | certificate |
| Fellow, American College of Physicians (FACP) | 7/2011 | ACP, Philadelphia, PA | certificate |
| AHA Connected at Heart Award | 3/2011 | AHA - Dayton Affiliate | — |
| NCQA Heart and Stroke Recognition Program | 2/2009 | NCQA, Washington, DC | certificate |
| Fellow, American Heart Association (FAHA) | 7/2008 | AHA, Dallas, TX | certificate |
| Fellow, American Society of Echocardiography (FASE) | 7/2008 | ASE, Morrisville, NC | certificate |
| Fellow, American College of Cardiology (FACC) | 9/2005 | ACC, Washington, DC | certificate |
| AHA Cardiovascular Provider of the Year, Central TX | 2/2004 | AHA - Austin Affiliate | Certificate needed |
| ACC/Littman Scholarship Award | 5/1999 | ACC, Washington, DC | — |
| MD with Highest Honors | 5/1994 | UNC School of Medicine | certificate certificate |
| UNC Distinguished Medical Scholars Program | 5/1992 - 5/1994 | UNC School of Medicine | certificate |
| NIH Student Research Grant | 2/1993 | National Institutes of Health | — |
| Burroughs Wellcome Fund Medical Student Grant | 5/1992 | Burroughs Wellcome Fund, RTP, NC | — |
| SCCT Founding Physician Certificate | — | Society of Cardiovascular Computed Tomography | certificate |
NPI / Medicare / Medicaid
NPI Number: 1326004896
Federal ID: 426004813
Enumeration Date: 04/25/2006
Medicare
PriMed Cardiology PTAN: H12635 (eff. 12/1/2005)
Clincare PTAN: H454870
Medicaid
Ohio Medicaid: 2595955 (eff. 10/14/2005)
Missouri Medicaid: 207420308 (eff. 7/25/2005)
Active State Medical Licenses
All 10 licenses confirmed active as of April 9, 2026. Expiration dates updated from MOC system. NC, GA, IL, VA expire July 2026 — renewal decisions pending collaborative review.
| State | License # | Issued | Expires | Practicing | Status | Documents |
|---|---|---|---|---|---|---|
| Colorado | DR.0067374 | 9/10/2021 | 4/30/2027 | No | Active | certificate |
| Georgia | 89480 | 7/1/2021 | 7/31/2026 | No | Active | Proof Needed Staged file is a renewal application; replace with certificate or board export. |
| Illinois | 036158334 | 9/21/2021 | 7/31/2026 | No | Active | Proof Needed |
| Indiana | 01061681A | 1/26/2006 | 10/31/2027 | Yes | Active | certificate |
| Kentucky | 46040 | 4/3/2013 | 3/1/2027 | Yes | Active | Proof Needed Staged file is a renewal receipt; replace with certificate or board export. |
| North Carolina | 9600057 | 12/20/1995 | 7/26/2026 | No | Active | certificate |
| Ohio | 35-087069 | 10/14/2005 | 1/1/2028 | Yes | Active | Certificate needed Renewal letters removed from this view. Use elicense.ohio.gov export or board-issued certificate. |
| Oregon | MD 203778 | 5/13/2021 | 12/31/2027 | No | Admin Medicine Active | certificate certificate |
| Texas | K6314 | 8/22/1998 | 2/28/2028 | No | Active | certificate |
| Virginia | 0101272971 | 8/4/2021 | 7/31/2026 | No | Active | Proof Needed |
View Full License Details (Board contacts, verification URLs, CME requirements)
Colorado
Board: Colorado Medical Board, 1560 Broadway, Suite 1350, Denver, CO 80202
Phone: (303) 894-7800 | Fax: (303) 894-7692
Email: dora_medicalboard@state.co.us
Verify: Online Lookup
Georgia
Board: Georgia Composite Medical Board, 2 Peachtree St NW, 6th Floor, Atlanta, GA 30303
Phone: (404) 656-3913 | Fax: (404) 656-9723
Email: medboard@dch.ga.gov
Verify: Online Lookup
Illinois
Board: IL DFPR, 320 W. Washington St, 3rd Fl, Springfield, IL 62786
Phone: (800) 560-6420
Email: FPR.MedicalUnit@illinois.gov
CME: 150 hours per 3-year cycle
Verify: Online Lookup
Indiana
Board: Medical Licensing Board of Indiana, 402 W. Washington St, Room W072, Indianapolis, IN 46204
Phone: (317) 234-2060 | Fax: (317) 233-4236
Email: pla3@pla.in.gov
CME: None required
Verify: Online Lookup
Kentucky
Board: Kentucky Board of Medical Licensure, 310 Whittington Pkwy, Ste 1B, Louisville, KY 40222
Phone: (502) 429-7150 | Fax: (502) 429-7158
Email: jessica.shelman@ky.gov
CME: 60 hours (30 AMA Cat I + 30 other)
Verify: Online Lookup
North Carolina
Board: NC Medical Board, PO Box 20007, Raleigh, NC 27619
Phone: (919) 326-1100 | (800) 253-9653
Email: license@ncmedboard.org
Verify: ncmedboard.org ($50 fee)
Ohio
Board: State Medical Board of Ohio, 30 E. Broad St, 3rd Floor, Columbus, OH 43215
Phone: (614) 466-3934 | Fax: (614) 728-5946
Email: license@med.ohio.gov
Verify: elicense.ohio.gov ($50 fee)
Oregon
Status Note: Administrative Medicine Active - permits UM/advisory work, NOT direct patient care
Board: Oregon Medical Board, 1500 SW 1st Ave, Suite 620, Portland, OR 97201
Phone: (971) 673-2700 | Fax: (971) 673-2670
Email: info@omb.oregon.gov
Verify: Veridoc
Texas
Board: Texas Medical Board, PO Box 2029 MC 245, Austin, TX 78768
Phone: (512) 305-7010 | Fax: (888) 512-2581
Email: Registrations@tmb.state.tx.us
Verify: Online Lookup (no fee)
Virginia
Board: Virginia Board of Medicine, 9960 Mayland Dr, Suite 300, Henrico, VA 23233
Phone: (804) 367-4600 | Fax: (804) 527-4426
Email: medbd@dhp.virginia.gov
Verify: Veridoc
Inactive State Medical Licenses
View Inactive Licenses (9 states)
| State | License # | Issued | Expired | Notes |
|---|---|---|---|---|
| Iowa (2005) | MD-36451 | 12/15/2005 | 7/1/2006 | Locum tenens |
| Iowa (2016) | MD-43883 | 10/19/2016 | 7/1/2018 | Locum tenens |
| Kansas | 04-40157 | 7/5/2017 | 7/31/2018 | Locum tenens |
| Missouri | 2002012695 | 6/12/2002 | 1/31/2007 | Capital CV Specialists era |
| Montana | MED-PHYS-LIC-58537 | 7/5/2017 | 3/31/2021 | Locum tenens |
| Oklahoma | 23867 | 6/28/2004 | 6/1/2014 | Oklahoma Heart Institute era |
| Oregon (temp) | MD161933 | 4/8/2013 | 1/2/2018 | Temporary license, locum tenens |
| Pennsylvania | MD463497 | 2/8/2018 | 12/31/2018 | Geisinger locum |
| West Virginia | 26297 (perm) / 2714 (temp) | 3/9/2015 | 6/30/2021 | Locum tenens |
| Wisconsin | 70989-20 | 5/7/2019 | 10/31/2021 | Inactive confirmed 3/3/2026 |
Federal DEA Registrations
Decision (2/27/2026): 3 of 4 DEA registrations lapsed. BS5929647 renewed 2/12/2025 (discovered 4/15/2026); now registered to Ohio.
| DEA # | State | Orig. Issued | Expired | Registered Address | Status | Documents |
|---|---|---|---|---|---|---|
| BS5929647 | Ohio | ~8/31/1998 | 2/29/2028 | 241 Summerford Place, Dayton, OH 45458 | Active | certificate |
| FS3728423 | Kentucky | 3/12/2013 | 2/28/2022 | Deaconess Heart Group, 1300 Merritt Dr, Henderson, KY | Lapsed | — |
| FS3728928 | Ohio | 3/12/2013 | 2/28/2025 | 241 Summerford Place, Dayton, OH | Lapsed | — |
| FS0843777 | Colorado | 9/24/2021 | 2/29/2024 | 241 Summerford Place, Dayton, OH | Lapsed | — |
| FS6445832 | Wisconsin | 11/18/2016 | 2/29/2020 | ThedaCare, 1818 N Meade St, Appleton, WI | Retired | — |
| FS6964375 | Indiana (2) | 7/20/2017 | 2/29/2020 | IU Health Methodist, 1701 Senate Blvd, Indianapolis, IN | Retired | — |
State Controlled Substance Registrations
| State | License # | Issued | Expired | Status |
|---|---|---|---|---|
| Indiana | 01061681B | 10/2/2012 | 10/31/2023 | Expired |
| Oklahoma | 32391 | 6/30/2004 | 10/31/2006 | Expired |
| Texas | A0181498 | 6/23/2011 | 6/30/2013 | Expired |
| Missouri | 232666718 | 6/27/2005 | 6/30/2006 | Expired |
Verification Contacts
| System | ID / Username | Details |
|---|---|---|
| CAQH | Provider ID: 11557357 | Password: [See secure credential store] |
| FCVS | Packet ID: 39292 | Federation ID: 212507131 | User: shah0006 | Password: [See secure credential store] |
| NPPES | NPI: 1326004896 | User: PriMed54 | Password: [See secure credential store] |
Training Certifications
| Course | Last Issued | Expired | Training Center / ID | Documents |
|---|---|---|---|---|
| ACLS | 3/25/2020 | 3/2022 EXPIRED | Louisville Metro EMS (KY03607) Card 206502592368 |
Proof |
| BLS | 10/23/2019 | 10/2021 EXPIRED | Baptist Hospital Paducah (KY01351) | Proof |
| Current cards (replace expired proofs after renewal) | Proof Needed | |||
CME / MOC Documents
Core current CME and MOC proof files from the organized CME root are linked here. Historical year folders remain in the source archive and are not individually summarized in this hosted packet.
| Record | Documents |
|---|---|
| AMA transcript (121 existing CME credits) | Proof |
| ABIM MOC credit confirmation | Proof |
| ABIM detailed MOC activity report (2017-2025) | Proof |
| Mayo Clinic Challenges in Clinical Cardiology (17.25 CE) | Proof |
| UpToDate internet point-of-care (4.0 CE) | Proof |
| OpenEvidence point-of-care (1 CE) | Proof |
| Suicide risk identification and response (1 CE) | Proof |
| Weill Cornell biometric monitoring in HF (1 CE) | Proof |
| California Heart Center antibodies / AMR in transplant (8 CE) | Proof |
Employment History
Most Recent Employment
Employer: Evicore Healthcare
Dates: 3/7/2022 - 1/31/2026
Title: Medical Director, Cardiology
Field: Utilization Management
Address: 400 Buckwalter Pkwy., Bluffton, SC 29910
Phone: (800) 918-8924
Current: Independent Physician
Dates: 2/1/2026 - Present
Activity: Credentialing maintenance, professional development, and career transition
Location: Dayton, OH
View All Prior Employment (25+ positions)
| Employer | Position/Type | Dates | Contact |
|---|---|---|---|
| All Star Healthcare Solutions | Locum Tenens | 6/28/2021 - 1/21/2022 | David Hittner (954) 580-2336 |
| ICON Medical Network | Locum Tenens | 2/22/2021 - 3/5/2021 | Victoria O'Malley (503) 783-6901 |
| Cross Country Locums | Locum Tenens | 9/28/2020 - 11/16/2020 | April Applewhite (678) 245-7069 |
| University of Louisville School of Medicine | Director, Advanced HF/MCS/Transplant | 11/1/2019 - 8/21/2020 | Mary Beth Oliver (502) 852-1837 |
| Clincare International Center | Multi-Specialty Group | 11/2018 - 10/3/2019 | Rajan Aurora (937) 429-2422 |
| Geisinger Heart Institute | Director, Advanced HF/MCS | 3/1/2018 - 8/17/2018 | Jeffrey Adams (570) 271-6466 |
| IU Health Methodist Hospital | Locum Advanced HF/Transplant | 1/11/2018 - 3/16/2018 | Main Line (317) 962-9700 |
| University of Iowa Hospitals | Locum Academic Cardiologist/Advanced HF | 11/14/2016 - 12/15/2017 | Barry London, MD (319) 383-1049 |
| Weatherby Healthcare | Locum Cardiologist | 1/8/2016 - 4/19/2019 | Joel Myers (919) 659-1670 |
| Medisync Midwest, LLC | Independent Consultant | 8/1/2016 - 10/8/2017 | Bob Matthews (513) 608-3645 |
| Next Medical Staffing | Locum Hospitalist | 1/15/2016 - 3/9/2017 | Terri Ball (937) 903-7316 |
| Hayes Locums | Locum Cardiologist | 8/21/2017 - 9/29/2017 | Thomas Hiemer (954) 613-0358 |
| Barton Associates | Locum Cardiologist | 9/12/2016 - 12/16/2016 | Derek Royall (512) 982-2496 |
| CardioSolution | Locum Cardiologist | 10/28/2013 - 10/28/2016; 8/30/2017 - 10/20/2020 | Seth Thomas (513) 386-6152 |
| CompHealth | Locum Cardiologist | 11/20/2015 - 4/3/2016 | Main Line (800) 453-3030 |
| University of Kentucky Med Ctr | AHF/Transplant Fellow | 7/1/2015 - 6/30/2016 | Sara Baird (859) 323-8040 |
| Emcare Inc. | Hospitalist/Nocturnist | 9/1/2013 - 12/1/2017 | Emily Ore (371) 783-7474 |
| PracticeMatch | Locum Hospitalist | 8/1/2012 - 12/31/2013 | Corporate Office St. Louis, MO |
| Locumtenens.com | Locum Hospitalist | 10/1/2012 - 3/21/2014 | Corporate Office Alpharetta, GA |
| Heart Attack & Stroke Prevention Ctr | Solo Concierge Practice | 10/4/2011 - 6/18/2012 | Practice closed Austin, TX |
| PriMed Cardiology | Private Practice, Board of Directors | 12/5/2005 - 3/4/2011 | Office Kettering, OH |
| Weatherby Locums | Locum Cardiologist | 7/10/2005 - 10/1/2005 | Corporate Office Ft Lauderdale, FL |
| Oklahoma Heart Institute | Private Practice Cardiology | 7/1/2004 - 7/30/2005 | Office Tulsa, OK |
| Capital CV Specialists | Private Practice Cardiology | 7/1/2002 - 6/14/2004 | Office Austin, TX |
| HeartCare Specialists | Private Practice Cardiology | 9/1/2000 - 4/30/2002 | Practice closed Dallas, TX |
| NeXT Computer, Inc. | Higher Education Marketing Consultant | 4/1991 - 8/1991 | Corporate Office Palo Alto, CA |
| Apple Computer, Inc. | Higher Education Market Specialist | 5/1989 - 4/1991 | Corporate Office Cupertino, CA |
| Cerebral Systems | President and Owner | 6/1988 - 4/1989 | Owner Charlotte, NC |
Chronological Activity
View Complete Chronological Timeline (1982 - Present)
| Dates | Activity | Location | Type |
|---|---|---|---|
| 9/1982 - 5/1984 | NC School of Science & Mathematics | Durham, NC | Education |
| 5/1984 - 8/1984 | Vacation (Travel to Europe) | Vacation | |
| 8/1984 - 5/1988 | University of Pennsylvania (BA Biochemistry) | Philadelphia, PA | Education |
| 6/1988 - 4/1989 | Cerebral Systems (President and Owner) | Charlotte, NC | Non-Clinical |
| 5/1989 - 4/1991 | Apple Computer, Inc. (Higher Education Market Specialist) | Cupertino, CA | Non-Clinical |
| 4/1991 - 8/1991 | NeXT Computer, Inc. (Higher Education Marketing Consultant) | Palo Alto, CA | Non-Clinical |
| 9/1989 - 5/1994 | UNC School of Medicine (MD) | Chapel Hill, NC | Education |
| 6/1992 - 9/1993 | Honors Research, Image-Guided Surgery | Chapel Hill/Boston | Education |
| 7/1994 - 6/1995 | Internship, Internal Medicine & Pediatrics | Duke, Durham, NC | Training |
| 7/1995 - 6/1997 | Residency, Internal Medicine | Duke, Durham, NC | Training |
| 7/1997 - 6/2000 | Fellowship, Cardiovascular Disease (Chief Fellow 7/1998-6/2000) | Baylor, Dallas, TX | Training |
| 7/2000 - 4/2002 | HeartCare Specialists (solo cardiology) | Dallas, TX | Clinical |
| 7/2000 - 6/2002 | RHD Memorial, Trinity Medical Center | Dallas/Carrollton, TX | Clinical |
| 9/2000 - 6/2002 | Medical City Dallas | Dallas, TX | Clinical |
| 11/2001 - 4/2002 | Presbyterian Hospital of Plano | Plano, TX | Clinical |
| 7/2002 - 6/2004 | Capital Cardiovascular Specialists | Austin, TX | Clinical |
| 7/2004 - 7/2005 | Oklahoma Heart Institute | Tulsa, OK | Clinical |
| 7/2005 - 10/2005 | Weatherby Locums (Ozarks Medical Center) | West Plains, MO | Locum |
| 10/2005 - 3/2006 | Fellowship, Advanced CV Imaging | St. Vincent, Indianapolis | Training |
| 12/2005 - 8/2011 | PriMed Cardiology (BOD, Dir CV Imaging) | Kettering/Dayton, OH | Clinical |
| 12/2005 - 8/2011 | Kettering, Sycamore, MVH, Good Samaritan | Dayton, OH area | Clinical |
| 1/2011 - 11/2011 | Clinical Inquest Center Ltd. | Beavercreek, OH | Research |
| 3/2011 - 7/2011 | Foot surgery and recovery | Medical Leave | |
| 10/2011 - 6/2012 | Heart Attack & Stroke Prevention Center | Austin, TX | Clinical |
| 10/2011 - 9/2012 | Multiple Austin hospitals (St. David's, Seton, Heart Hospital) | Austin, TX | Clinical |
| 8/2012 - 3/2014 | Locum hospitalist (MedCentral, Drake, Good Sam, Memorial, Community Hosp South, etc.) | OH, IN, OR | Locum |
| 9/2013 - 12/2017 | Emcare (hospitalist/nocturnist, part-time) | Indianapolis, IN | Clinical |
| 10/2013 - 10/2016 | CardioSolution (Highlands Regional, KY) | Prestonsburg, KY | Locum |
| 7/2015 - 7/2016 | Fellowship, Advanced HF & Transplant | UK Medical Center, Lexington | Training |
| 1/2016 - 3/2017 | Next Medical Staffing (hospitalist) | OH, KY | Locum |
| 8/2016 - 10/2017 | Medisync Midwest (consultant) | Cincinnati, OH | Non-Clinical |
| 9/2016 - 12/2016 | Barton Associates (Baptist Heart Murray) | Murray, KY | Locum |
| 11/2016 - 12/2017 | University of Iowa (Advanced HF/Transplant) | Iowa City, IA | Academic |
| 8/2017 - 12/2017 | Weatherby (Olathe Medical Center) | Olathe, KS | Locum |
| 8/2017 - 9/2017 | Hayes Locums (Billings Clinic) | Billings, MT | Locum |
| 1/2018 - 3/2018 | IU Health Methodist (Advanced HF/Transplant) | Indianapolis, IN | Locum |
| 3/2018 - 8/2018 | Geisinger (Dir, Advanced HF/MCS) | Danville, PA | Academic |
| 12/2018 - 4/2019 | Weatherby (Plymouth Medical Center) | Plymouth, IN | Locum |
| 8/2017 - 10/2020 | CardioSolution (multiple KY/WV sites) | KY, WV | Locum |
| 11/2018 - 10/2019 | Clincare International Center | Beavercreek, OH | Clinical |
| 11/2019 - 8/2020 | University of Louisville (Dir, Advanced HF/MCS/Transplant) | Louisville, KY | Academic |
| 9/2020 - 11/2020 | Cross Country (Greenbrier Valley MC) | Ronceverte, WV | Locum |
| 2/2021 - 3/2021 | ICON Medical (Adventist Health Portland) | Portland, OR | Locum |
| 6/2021 - 1/2022 | All Star Healthcare (Mercy Durango, Mercyhealth Janesville) | CO, WI | Locum |
| 3/2022 - 1/2026 | Evicore Healthcare (Medical Director, Cardiology UM) | Remote / Bluffton, SC | UM |
| 2/2026 - Present | Independent Physician (credentialing maintenance, professional development, career transition) | Kettering, OH | Independent |
Hospital Affiliations
View All Hospital Affiliations (40+ facilities)
Most Recent
| Hospital | Location | Dates | Status | Credentialing Contact |
|---|---|---|---|---|
| Mercy Regional Medical Center | Durango, CO | 10/11/2021 - 1/2022 | Inactive | Amy Weaver, (620) 272-2226 |
| Mercyhealth Hospital & Trauma Ctr | Janesville, WI | 6/28/2021 - 7/20/2021 | Inactive | Mary Combs, (608) 756-6807 |
| Adventist Health Portland | Portland, OR | 2/22/2021 - 3/5/2021 | Inactive | Luanne Lasage, (503) 251-6166 |
| Greenbrier Valley Medical Center | Ronceverte, WV | 9/28/2020 - 11/16/2020 | Inactive | Brenda Holliday, (304) 647-4411 |
| UofL Health Jewish Hospital | Louisville, KY | 11/25/2019 - 8/21/2020 | Inactive | Kimberly Martin, (502) 587-4426 |
| University of Louisville Hospital | Louisville, KY | 11/25/2019 - 8/21/2020 | Inactive | Kimberly Martin, (502) 587-4426 |
| Highlands ARH Regional Med Ctr | Prestonsburg, KY | 8/26/2019 - 10/20/2020 | Inactive | Cheryl Blair, (606) 886-7603 |
| Whitesburg ARH Hospital | Whitesburg, KY | 5/13/2019 - 10/4/2019 | Inactive | Kim Napier, (606) 439-6934 |
| Beckley ARH Hospital | Beckley, WV | 5/6/2019 - 5/13/2019 | Inactive | June Goode, (304) 255-3246 |
| Murray-Calloway County Hospital | Murray, KY | Multiple dates (2016, 2019) | Inactive | Jennifer Rehmus, (270) 762-1935 |
| ThedaCare Regional MC - Appleton | Appleton, WI | 5/29/2019 - 7/28/2019 | Inactive | Laura Leininger, (920) 454-8022 |
| ThedaCare Regional MC - Neenah | Neenah, WI | 5/29/2019 - 7/28/2019 | Inactive | Laura Leininger, (920) 454-8022 |
| Plymouth Medical Center | Plymouth, IN | 12/3/2018 - 6/1/2019 | Inactive | Jocelyn Mitchell, 574.335.2535 |
| Geisinger Medical Center | Danville, PA | 3/19/2018 - 8/17/2018 | Inactive | Traci Moser, (570) 214-9539 |
| Geisinger Wyoming Valley MC | Wilkes-Barre, PA | 3/19/2018 - 8/17/2018 | Inactive | (same as above) |
| IU Health Methodist Hospital | Indianapolis, IN | 1/12/2018 - 3/16/2018 | Inactive | (medical staff office) |
| Billings Clinic | Billings, MT | 8/21/2017 - 9/29/2017 | Inactive | Yvette Frey, (406) 657-4145 |
| Olathe Medical Center | Olathe, KS | 8/7/2017 - 12/8/2017 | Inactive | Traci Lewin, (913) 791-4208 |
| University of Iowa Hospitals | Iowa City, IA | 11/14/2016 - 12/15/2017 | Inactive | Alicia Messer, (319) 384-6152 |
| Atrium Medical Center | Middletown, OH | 1/15/2016 - 8/29/2016 | Inactive | Pat Lowman, (937) 208-2055 |
| Miami Valley Hospital | Dayton, OH | 5/27/2016 - 9/2/2016 | Inactive | Margie Daniel, (937) 208-6356 |
| Pikeville Medical Center | Pikeville, KY | 12/21/2016 - 3/9/2017 | Inactive | Sherri Thacker, (606) 218-4504 |
| Baptist Health Corbin | Corbin, KY | 1/8/2016 - 1/10/2016 | Inactive | Brenda Brewer, (606) 523-8688 |
| Our Lady of Bellefonte Hospital | Ashland, KY | 11/20/2015 - 4/3/2016 | Inactive | Lisa Huff, (606) 833-4141 |
| University of Kentucky MC | Lexington, KY | 7/1/2015 - 6/30/2016 | Inactive | Ashlee Rodenhauser, (859) 323-8040 |
| Highlands Regional MC | Prestonsburg, KY | 10/28/2013 - 10/28/2016 | Inactive | Cheryl Blair, (606) 886-7603 |
| Community Hospital South | Indianapolis, IN | 2/21/2013 - 8/21/2014 | Inactive | Nancy Steele, (317) 887-7152 |
| Providence Medford MC | Medford, OR | 5/10/2013 - 1/10/2014 | Inactive | Trudie Williams, (503) 215-0723 |
| St. Elizabeth ME East & Central | Lafayette, IN | 4/20/2013 - 10/16/2013 | Inactive | Terri Spain, (765) 502-4380 |
| Good Samaritan Hospital | Vincennes, IN | 1/21/2013 - 12/31/2013 | Inactive | Medical Staff, (812) 885-3919 |
| Memorial Hospital | Jasper, IN | 10/15/2012 - 12/31/2013 | Inactive | Michelle Rose, (812) 996-0675 |
| Drake Medical Center | Cincinnati, OH | 10/1/2012 - 3/21/2014 | Inactive | Ann Shelley, (513) 585-8119 |
| MedCentral Health System | Mansfield, OH | 8/1/2012 - 10/31/2012 | Inactive | Sandi Freeman, (419) 526-8581 |
| Blanchard Valley MC | Findlay, OH | 8/5/2012 - 9/22/2012 | Inactive | Traci Roth, (419) 423-5160 |
| Multiple Austin hospitals (St. David's, Seton, Heart Hospital, Westlake, Lakeway) | Austin, TX | 10/2011 - 3/2013 | Inactive | Various (see original) |
| Kettering Medical Center | Kettering, OH | 12/1/2005 - 8/12/2011 | Inactive | Sue McCall, (937) 395-8324 |
| Sycamore Medical Center | Miamisburg, OH | 12/1/2005 - 8/12/2011 | Inactive | Sue McCall, (937) 395-8324 |
| Miami Valley Hospital | Dayton, OH | 12/1/2005 - 8/12/2011 | Inactive | Pat Lowman, (937) 208-2055 |
| Good Samaritan Hospital | Dayton, OH | 12/1/2005 - 8/12/2011 | Inactive | Susan Willis, (937) 734-1212 |
| Ozarks Medical Center | West Plains, MO | 7/10/2005 - 10/1/2005 | Inactive | Dona Paschall, (417) 256-9111 |
| Hillcrest & Southcrest MCs | Tulsa, OK | 7/6/2004 - 8/2005 | Inactive | (see original) |
| RHD Memorial, Trinity, Medical City | Dallas, TX | 7/2000 - 6/2002 | Inactive | (see original) |
| Presbyterian Hospital of Plano | Plano, TX | 11/1/2001 - 4/1/2002 | Inactive | Sherry Schulze, (972) 981-3365. Reason: Voluntarily resigned due to loss of interventional cardiology backup coverage |
Procedure / Activity Logs
Procedure and activity logs are linked as source documents. These are proof files, not a normalized procedure-count summary.
Procedure / Activity Source Documents
Academic / Teaching Appointments
| Institution | Title | Department | Dates | Status |
|---|---|---|---|---|
| University of Louisville | Asst Professor of Medicine; Director, Advanced HF/MCS/Transplant | Internal Medicine, Div CV Medicine | 11/2019 - 8/2020 | Inactive |
| Geisinger Medical Center | Asst Professor; Director, Advanced HF/MCS | Internal Medicine, Div CV Medicine | 3/2018 - 8/2018 | Inactive |
| University of Iowa | Visiting Clinical Asst Professor of Medicine | Internal Medicine, Div CV Medicine | 12/2016 - 12/2017 | Inactive |
| Ohio State University | Adjunct Clinical Asst Professor of Medicine | Internal Medicine, Div CV Medicine | 4/2008 - 6/2020 | Inactive |
| Kettering Medical Center | Asst Program Director, Cardiology Fellowship | Internal Medicine, Div CV Medicine | 2/2008 - 4/2011 | Inactive |
| Baylor University Medical Center | Chief Cardiology Fellow | Internal Medicine, Div CV Medicine | 7/1998 - 7/2000 | Inactive |
| The Wharton School, U of Pennsylvania | Instructor | Decision Science | 9/1987 - 5/1988 | Inactive |
Malpractice Liability Insurance
Current Coverage: None NO ACTIVE POLICY
Last Coverage: eviCore Healthcare employer-provided (ended 1/31/2026)
Note: No individual malpractice policy currently in force. Will need to obtain coverage upon new clinical or medical director appointment.
Malpractice Insurance Source Documents
- Recent locums COIs: Mercy Regional COI Mercyhealth COI
- Claims detail packets: not staged for PDF preview in this pass because they are sensitive legal/claims materials.
View Historical Insurance Policies
| Carrier | Holder/Facility | Policy # | Effective | Expired | Coverage | Type |
|---|---|---|---|---|---|---|
| Aspen Specialty | Mercy Regional MC, Durango, CO (All Star) | MM00HPM20 | 8/9/2020 | 2/9/2022 | $1M/$3M | Occurrence |
| Aspen Specialty | Mercyhealth Janesville, WI (All Star) | MP119791 | 10/28/2020 | 10/28/2021 | $1M/$3M | Occurrence |
| TDC Specialty | Greenbrier Valley MC, WV (Cross Country) | CT-2021-0089 | 9/28/2020 | 11/16/2020 | $1M/$3M | Occurrence |
| Allied World Surplus Lines | Adventist Health Portland, OR (ICON) | 0309-6614 | 2/22/2021 | 3/5/2021 | $1M/$3M | Occurrence |
| Coverys/ProSelect | UofL Health (University of Louisville) | Various | 11/2019 | 8/2020 | $1M/$3M | Claims-Made |
| National Fire & Marine | Various (Weatherby Healthcare) | Various | Multiple periods | 4/19/2019 | $1M/$3M | Claims-Made |
| Geisinger Insurance Corp, RRG | Geisinger Medical Center | Self-insured | 3/2018 | 8/2018 | $1M/$3M | Self-Insured |
| Medical Protective | PriMed Cardiology (Dayton era) | 711683 | 2005 | 2011 | $1M/$3M | Occurrence |
Malpractice Claims History
1. Willie Reese - Settled ($400,000)
Date of Occurrence: 3/13/2008
Place: Kettering Medical Center, Kettering, OH
Filed: 4/8/2009 | Court: Common Pleas, Montgomery County, Case #2009 CV 02878
Settlement Date: 8/24/2015
Amount: $400,000
Carrier: Medical Protective Company, Policy #711683
Plaintiff Attorney: Dwight Brannon, (937) 228-2306
Defense Attorney: Susan Blasik-Miller, Freund Freeze & Arnold, (937) 913-0165
Role: Primary Defendant (Attending Physician)
NPDB Report: Yes
Death: Yes
Allegation: Failure to diagnose coronary artery disease. Patient was a 60-year-old male with no cardiac history who presented for possible syncope (more consistent with falling asleep at work). Normal stress test, echo, no MI or arrhythmia. Discharged for outpatient monitoring; patient failed to pick up ordered ambulatory monitor. Died suddenly 2 days later. Autopsy: CAD but no prior MI, structurally normal heart. Case dismissed 12/28/2012, refiled 12/23/2013. Carrier settled on first day of trial (8/24/2015) when plaintiff reported family emergency preventing proceedings, rather than rescheduling after 7 years.
2. John Reed - Dismissed Without Prejudice
Date of Occurrence: 1/4/2007
Place: Kettering Medical Center
Filed: 2/20/2009 | Case #2009 CV 01312
Resolution: Dismissed without prejudice
NPDB: No | Death: Yes
Elderly male died 2 months after intervention by partner (interventional cardiologist). Named as co-defendant as referring physician. Lawsuit dropped shortly after filing. No settlement, no trial.
3. James Heikes - Dismissed Without Prejudice
Date of Occurrence: 3/6/2009
Place: Kettering Medical Center
Resolution: Dismissed - wrongly named
NPDB: No | Death: Yes
ICU patient under care of Hemant Shah, MD (pulmonary/critical care). Never involved in the patient's care. Wrongly named and subsequently dropped. No trial, no settlement.
4. Marlene Newman - Dismissed Without Prejudice
Date of Occurrence: 10/14/2009
Place: Kettering Medical Center
Resolution: Dismissed - dropped from case
NPDB: No | Death: No
50-year-old female with failed arterial bypass surgery. Peripherally involved in care. Named to increase potential settlement due to surgeon's limited coverage. Case settled between plaintiff and surgeon; dropped from case. No trial.
Board Actions, Privilege Actions & Employment Actions
All disclosable regulatory, hospital privilege, and employment actions. Malpractice claims are documented separately above. Disclosure language for Oregon MB and eviCore matters reviewed by Thomas Cooney (4/9/2026).
1. Texas Board of Medical Examiners Complaint (2003) CLOSED - No Action
File #: 03-1293
Allegation: Practice Inconsistent with Public Health and Welfare (Texas Medical Practice Act §164.051(a)(6))
Patient: James Donald Sheetz, Sr.
Encounter: Summer 2001, RHD Hospital, Dallas, TX (HeartCare Specialists era)
Complaint Opened: 5/22/2003
Outcome: CLOSED — No Action Recommended — 12/18/2003. "Evidence does not indicate a violation of the Texas Medical Practice Act."
NPDB: No — closed with no action, not reportable
Disclosed Since: September 2018 (Goldfish Locum Tenens application); consistently disclosed on all subsequent applications
Established Disclosure Language (in use since 2018)
"On May 2, 2003 I was notified of a complaint filed with the Texas State Board of Medical Examiners that an allegation of 'Practice Inconsistent with Public Health and Welfare' was filed. This automatically initiated an investigation on the part of the Texas Medical Board. The Texas Medical Board requested a response which I provided to them. The information provided to them was satisfactory. The allegation was dismissed with no action recommended since no evidence was found to substantiate the allegation."
Source: Deaconess Symplr Portal, Section F, Q6 (6/29/2021) and Goldfish Locum Tenens (9/25/2018)
Clinical Context
Elderly patient James Donald Sheetz Sr. presented 6/26/2002. Acutely ill, hypotensive — assessed as CHF exacerbation vs. urosepsis. Patient and son refused hospitalization and ER despite strong urging. Prescribed empirical Levaquin, arranged follow-up. Patient never returned. Complaint filed by family. Medical records provided to Board via notarized HeartCare Specialists affidavit (24 pages).
2. Oregon Medical Board — Self-Reported Licensing Matter (2026) PENDING
Case No: 26-0100
Nature: Self-reported license lapse. Oregon license MD203778 changed to Inactive 8/30/2024 after failure to provide an Oregon practice address per ORS 677.172. Practice continued in utilization management (administrative, non-clinical) without knowledge of status change, 8/30/2024 – 1/9/2026.
Self-Report Filed: 1/22/2026 — letter from Tushar N. Shah, MD, submitted via attorney Thomas Cooney prior to any board-initiated action
Board Case Opened: 2/20/2026 (following receipt of self-report)
License Status: Restored to Active 1/9/2026 (reactivation application RA104452); currently Admin Medicine Active, expires 12/31/2027
Estimated Cases: ~200-300 UM cases reviewed during lapse period (peer-to-peer consultations and medical necessity determinations)
Attorney: Thomas M. Cooney, Cooney, Cooney and Madigan, LLC, (503) 607-2720, tmcooney@cooneyllc.com
Expected Outcome: Per attorney (1/20/2026 call): fine or reprimand most likely; suspension not expected. Reprimand is the lowest level of discipline.
NPDB: TBD — depends on outcome
Chronology (from self-report letter 1/22/2026)
| Date | Event |
|---|---|
| 12/29/2023 | Submitted renewal application for MD203778 with $580 fee. Listed Ohio home address (UM role, no Oregon patients). Printed active certificate (eff. 1/1/2024, exp. 12/31/2025). |
| 12/29/2023 | Oregon MB letter sent: "You did not provide us with an Oregon practice address. Per ORS 677.172... We have granted you six months at Active status. If we have not received an Oregon practice address by July 1, 2024, we will change your license status to Inactive." Letter not recalled or acted upon. |
| 7/1/2024 | Deadline for Oregon practice address passed without response. |
| 8/30/2024 | Oregon MB changed license to Inactive. Multiple contact attempts made. None received or recognized. |
| 12/28/2025 | Submitted standard renewal application with $682 fee. Printed new active certificate (exp. 12/31/2027). Did not realize status was Inactive. |
| 1/2/2026 | Paula Owens (eviCore credentialing) identified "Inactive" status on certificate. |
| 1/5/2026 | Joint call with Oregon MB. Representative explained Inactive = no practice in any capacity. Reactivation required. |
| 1/6/2026 | Reactivation application submitted with new photo and fingerprints. |
| 1/9/2026 | License restored to Active status. |
| 1/12/2026 | eviCore terminated employment for Code of Conduct non-compliance. |
| 1/20/2026 | Fee agreement signed with Thomas Cooney ($400/hr, $1,500 retainer). |
| 1/22/2026 | Self-report letter submitted to Oregon MB via attorney. |
| 2/20/2026 | Board opened Case 26-0100 following receipt of self-report. |
| 4/9/2026 | Status check email sent to Cooney (CC: Julie Comer). No board correspondence received since self-report. Multi-state notification confirmed not required until formal investigation opened. |
| 4/9/2026 | OMB public verification portal checked (omb.oregon.gov): "There are no current or prior Board actions or agreements on file for this licensee or registrant." No formal action has been taken. |
Key Context for Disclosure
- Role was purely administrative (utilization management) — no direct patient care, no Oregon patients seen
- Misunderstanding of Oregon's "Inactive" definition: assumed it noted absence of clinical practice, not a prohibition on all practice
- Both employer and physician believed license was active throughout 2025
- Self-reported voluntarily before any board action was initiated
- License restored within 4 business days of reactivation application
- Multi-state notification not required until formal investigation opened (per Cooney, 4/9/2026)
- Per ORS 677.425, Board matters are confidential — do not disclose details beyond what is required by the specific application question
- Attorney review completed. Disclosure language approved by Thomas Cooney (4/9/2026).
3. Presbyterian Hospital of Plano — Voluntary Privilege Termination (2002) RESOLVED
Facility: Presbyterian Hospital of Plano, Plano, TX
Affiliation: 11/1/2001 – 4/1/2002
Nature: Voluntary termination of clinical privileges due to inability to provide backup interventional cardiology coverage as a solo practitioner
Investigation: No — not under investigation at time of termination
NPDB: No
Disclosed Since: 2018 (consistently on all applications)
Established Disclosure Language (in use since 2018)
"My clinical privileges at Presbyterian Hospital of Plano were automatically and voluntarily terminated in the Spring of 2002 due to failure to provide a backup interventional cardiology coverage physician. I was a solo practitioner and was unable to find backup coverage to fulfill the criteria for continued medical staff membership. The competing cardiology group at this hospital was not willing to provide coverage for physicians not directly affiliated with their group. The interventional cardiologist who originally provided this coverage switched groups and joined a competing group that forbade him covering me for political reasons. For this reason, I volunteered to have my clinical privileges automatically withdrawn."
Credentialing contact: Sherry Schulze, (972) 981-3365
4. eviCore Healthcare — Employment Separation (2026)
Employer: eviCore Healthcare (Cigna)
Position: Medical Director, Cardiology
Dates: 3/7/2022 – 1/31/2026 (effective separation 1/12/2026)
Circumstance: Oregon license was administratively changed to Inactive without physician's knowledge (missing Oregon practice address per ORS 677.172 — not a clinical or ethical violation). Resolved within 4 business days of discovery. eviCore was also eliminating positions during this period.
Attorney Review: Disclosure language reviewed by Thomas Cooney (4/9/2026).
Professional Organizations
- American College of Cardiology
- American College of Physicians
- American Heart Association
- American Society of Echocardiography
- American Society of Transplantation
- Heart Failure Society of America
- International Society for Heart & Lung Transplantation
- Society for Cardiovascular CT
- Society for Cardiovascular Magnetic Resonance
Publications
Mazimba S, Grant N, Parikh A, Patel T, Dahale B, Franco Z, Dittoe N, Shah T, Hahn H. Comparison of the 2006 and 2010 Cardiac CT Appropriateness Criteria in a Real-World Setting. Journal of the American College of Radiology. 2012. 9(9):630.
Professional References
Current Principal References
Active list for credentialing applications. Verify contact details against the most recent reference letter PDFs before use.
| Name | Title/Specialty | Affiliation | Dates of Contact | Phone / Email | Address |
|---|---|---|---|---|---|
| Naresh K Solankhi, MD | Interventional Cardiology | University of Louisville Physicians | 11/2019 - Present | (502) 640-0336 (mobile) nsolankhi65@gmail.com | Louisville, KY |
| Vikas Singh, MD, FACC, FSCAI | Interventional Cardiology | Baptist Health Floyd | 7/2022 - Present | (786) 991-8555 (mobile) | New Albany, IN |
| Chakradhari Inampudi, MD | Advanced Heart Failure and Transplantation | MUSC Health University Medical Center | 2020 - Present | (248) 766-8287 (mobile) chakradhari_5757@yahoo.com | Charleston, SC |
| Sula E Mazimba, MD, MPH | Advanced Heart Failure and Transplantation | AdventHealth Orlando | 12/2005 - Present | (937) 901-0215 (mobile) sumazi@hotmail.com | Orlando, FL |
| Hyeun S "Tom" Park, MD | Cardiology | eviCore Healthcare | 3/2022 - 2/2026 | (718) 986-7987 (mobile) htparkmd@gmail.com | Mountain Lakes, NJ |
| Sharon Nichols, DO, FACC, MBA | Cardiology | eviCore Healthcare | 3/2022 - 2/2026 | (407) 636-1628 (mobile) Tkrdoc@msn.com | Altamonte Springs, FL |
| Steve Bergerman, MD, PhD | Cardiology | eviCore Healthcare | 3/2022 - 2/2026 | (914) 310-5448 (mobile) Steve.Bergerman@evicore.com | Florida |
Additional references available on request.
📋 Reference Archive — Internal Use Only
The sections below are operational/audit content for Tushar's reference management. Not part of the credentialing-grade reference list above. Do not include in credentialing application packets.
Reference Archive
Person-centered internal archive combining historical references, recommendations discovered from files, and reference-letter PDFs on disk. Shared multi-signer PDFs are repeated under each applicable signer for fast lookup.
| Name | Reference Type | Title / Relationship | Affiliation | Era / Context | Phone / Email | Address | Documents |
|---|---|---|---|---|---|---|---|
| Naresh K Solankhi, MD | Current Principal (cross-listed) | Interventional Cardiology | University of Louisville Physicians | U of L era | (502) 640-0336 (mobile) nsolankhi65@gmail.com | Louisville, KY | — |
| Vikas Singh, MD, FACC, FSCAI | Current Principal (cross-listed) | Interventional Cardiology | Baptist Health Floyd | U of L era | (786) 991-8555 (mobile) | New Albany, IN | — |
| Sula E Mazimba, MD, MPH | Current Principal (cross-listed) | Advanced Heart Failure and Transplantation | AdventHealth Orlando | Kettering era and ongoing | (937) 901-0215 (mobile) sumazi@hotmail.com | Orlando, FL | Proof |
| Himachala R. Veligandla, MD | Historical | Interventional Cardiology | Middlesboro ARH Hospital | Locums era | (606) 219-0828 (mobile) himachalrao@yahoo.com | Middlesboro, KY | Proof |
| Laura Richardson | Historical / Patient Testimonial | Patient Testimonial | n/a (patient) | University of Iowa Hospitals era | (515) 360-7859 (mobile) | Iowa City, IA | Proof |
| M Niranjan Reddy, MD, FACC | Historical | Interventional Cardiology | Kettering Physician Network | Kettering era | (937) 416-7251 (mobile) niranjanusa@hotmail.com | Dayton, OH | Proof |
| Anthony C. Stumbo, MD | Historical | Internal Medicine | Highlands ARH Regional Medical Center | Locums era | (606) 886-7645 (mobile) Stumbomd@yahoo.com | Prestonsburg, KY | Proof |
| Chittoor Bhaskar Sai-Sudhakar, MD | Historical | Cardiothoracic Surgery | UConn Health | Kettering era | (614) 203-1733 (mobile) | Farmington, CT | Proof |
| Sharon Beth Larson, DO, MS, FACOS, FACS | Historical | Cardiothoracic Surgery | Baptist Memorial Hospital | University of Iowa Hospitals era | (901) 226-0456 (Baptist CV & Thoracic Surgery dept) | Memphis, TN | Proof |
| Terry Mack | Historical / Patient Testimonial | Patient Testimonial | BWI Group | Kettering era. DECEASED. | n/a (deceased) | Kettering, OH | Proof |
| Clyde W. Yancy, MD, MSc, MACC, FAHA, MACP, FHFSA | Historical | Division Chief, Advanced Heart Failure and Transplant Cardiology | Northwestern University, Feinberg School of Medicine | Cardiology fellowship era and ongoing | (312) 926-2492 (office) cyancy@nmff.org | Chicago, IL | — |
| Hazaim Alwair, MD, FRCSEd (C-Th) | Discovered | Cardiothoracic Surgery | Charleston Area Medical Center (CAMC) | UofL era | (304) 388-5395 (mobile) hazaim.alwair@outlook.com | Charleston, WV | — |
| Shahab Ghafghazi, MD, FACC | Discovered | Cardiology | UofL Physicians | UofL era | (972) 693-3328 (mobile) shahab.ghafghazi@louisville.edu | Louisville, KY | — |
| Rajdeep S. Gaitonde, DO | Discovered | Electrophysiology | UofL Health | UofL era | (502) 581-1951 (mobile) | Louisville, KY | — |
| Matthew Bessen, MD | Discovered | Cardiology | UofL Health | UofL era | (502) 262-2560 (mobile) (502) 585-4321 (work) | Louisville, KY | — |
| Jeffrey M. Stidam, MD | Discovered | Electrophysiology | UofL Health | UofL era | (502) 599-0346 (mobile) stidam@gmail.com | Louisville, KY | — |
| Mitchell T. Saltzberg, MD, MSc | Discovered / HFSA | Heart Failure / Transplant Cardiology | ProHealth Care | HFSA fellowship application | Institutional contact via ProHealth Care, Waukesha WI | Waukesha, WI | Proof |
| Michelle M. Kittleson, MD, PhD | Discovered / HFSA | Heart Failure / Transplant Cardiology | Smidt Heart Institute, Cedars-Sinai | HFSA fellowship application | (310) 423-3277 (department/office) michelle.kittleson@cshs.org | Los Angeles, CA | Proof |
Verification log: last refresh 2026-05-11 (historical, discovered, and on-file reference-letter PDFs merged into person-centered archive table; non-letter reference-list files excluded).
Professional Information Summary — Tushar N. Shah, MD — Updated May 17, 2026