Active NPI
Paul E. Shuttleworth Jr., RN, CCP
- Perfusionist
- South San Francisco, CA
National Provider Identifier
1003936956
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Perfusionist
- License
- 830077
- Practice address
- 38 Highcrest LN
South San Francisco, CA 94080-7303 - Phone
- (650) 321-9999
- Fax
- (650) 615-9995
- NPI assigned
- Mar 31, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Perfusionist | 242T00000X | 830077 | CA | Primary |
Addresses
Primary practice location
38 Highcrest LN
South San Francisco, CA 94080-7303
Mailing address
38 Highcrest LN
South San Francisco, CA 94080-7303
Phone (650) 321-9999
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 830077 | CA | MD | Perfusionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003936956",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "38 HIGHCREST LN",
"city": "SOUTH SAN FRANCISCO",
"state": "CA",
"postal_code": "940807303",
"telephone_number": "650-321-9999",
"fax_number": "650-615-9995"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "38 HIGHCREST LN",
"city": "SOUTH SAN FRANCISCO",
"state": "CA",
"postal_code": "940807303",
"telephone_number": "650-321-9999",
"fax_number": "650-615-9995"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHUTTLEWORTH",
"first_name": "PAUL",
"middle_name": "E.",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "RN, CCP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "242T00000X",
"taxonomy_group": "",
"desc": "Perfusionist",
"state": "CA",
"license": "830077",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.