Individual provider Active NPI

Shane Michael Anderson, PA-C

  • Physician Assistant
  • Temple Terrace, FL
National Provider Identifier
1003509100
Registry record updated Mar 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
5901 E Fowler Ave Ste 100
Temple Terrace, FL 33617-2305
Phone
(813) 978-9700
Fax
(813) 558-6185
NPI assigned
Jun 2, 2023
Last updated
Mar 26, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 26, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

5901 E Fowler Ave Ste 100
Temple Terrace, FL 33617-2305

Mailing address

5901 E Fowler Ave Ste 100
Temple Terrace, FL 33617-2305

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230806000006 FL Practitioner - Physician Assistant 8820459902 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2414 Enterprise Rd
Florida Orthopaedic Institute
Clearwater, FL 33763-1751
Phone (813) 978-9700

3334 Capital Medical Blvd
Suite 400
Tallahassee, FL 32308-4470
Phone (850) 877-8174

430 Morton Plant St
Suite 301
Clearwater, FL 33756-3395
Phone (813) 978-9700

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Musculoskeletal Institute Chartered CurrentSince Sep 6, 2023 Accepting new patients
Tallahassee Orthopedic Clinic III, P.L. CurrentSince Nov 26, 2024 Accepting new patients
Musculoskeletal Institute Chartered CurrentSince Sep 6, 2023 Accepting new patients

Locations

2414 Enterprise Rd
Clearwater, FL 33763
Phone (727) 796-4345

2414 Enterprise Rd
Ste 301
Clearwater, FL 33763

430 Morton Plant St
Ste 206
Clearwater, FL 33756
Phone (727) 298-5230

430 Morton Plant St
Ste 301
Clearwater, FL 33756

13020 N Telecom Pkwy
Temple Terrace, FL 33637

13020 N Telecom Pkwy
Fl Orthopaedic
Temple Terrace, FL 33637

13060 N Telecom Pkwy
Fl Orthopaedic
Temple Terrace, FL 33637

5901 E Fowler Ave
Ste 100
Temple Terrace, FL 33617
Phone (813) 987-9700

2044 Trinity Oaks Blvd
Ste 110
Trinity, FL 34655
Phone (813) 978-7000

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: shane.anderson.1@18802.direct.athenahealth.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1685664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742947200000",
    "number": "1003509100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5901 E FOWLER AVE STE 100",
            "city": "TEMPLE TERRACE",
            "state": "FL",
            "postal_code": "336172305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5901 E FOWLER AVE STE 100",
            "city": "TEMPLE TERRACE",
            "state": "FL",
            "postal_code": "336172305",
            "telephone_number": "813-978-9700",
            "fax_number": "813-558-6185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "SHANE",
        "middle_name": "MICHAEL",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-02",
        "last_updated": "2025-03-26",
        "certification_date": "2025-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Temple Terrace, FL

Sources for this page

Verify at the official NPI Registry.