Shane Martin Wible, MPAS, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

6792106-1206 Issued in UT

Practice address

60 Merritt Blvd
Suite 106
Fishkill, NY 12524-2990

Phone

(845) 905-5090

NPI assigned

Nov 28, 2007

Last updated

Jul 24, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Physician Assistant

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ellenville Emergency Medical Associates PLLCGroup PAC ID 9436478658, 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ellenville Regional Hospital Hospital, Ellenville, NY, CCN 331310

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shane.wible.1@13746.direct.athenahealth.com
• Direct secure messaging: swible471665@direct.uvmhealth.org

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.

• Ellenville Emergency Medical Associates PLLC

  • Emergency Medicine Physician
  • Ellenville, NY
  • NPI 1477945905
  Medicare reassignment Care Compare group
• Nes Medical Services of New York PC

  • Emergency Medicine Physician
  • Bath, NY
  • NPI 1215455191
  Medicare reassignment NPD
• Eos Medical Group PC

  • Emergency Medicine Physician
  • Carmel, NY
  • NPI 1730119926
  NPD (past)
• Acoma-Canoncito-Laguna Indian Health Center

  • Health Service Clinic/Center
  • Acoma, NM
  • NPI 1225103922
  NPD (past)
• Haaku Health

  • Health Service Clinic/Center
  • San Fidel, NM
  • NPI 1962384438
  NPD (past)
• University Health Care Quick Clinic

  • Physician Assistant
  • Holladay, UT
  • NPI 1376645671
  NPD (past)

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

• Westchester-Ellenville Hospital, Inc.

  • Critical Access Hospital
  • Ellenville, NY
  • NPI 1073525341
  Care Compare affiliation

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

{
    "created_epoch": "1196208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374624000000",
    "number": "1013199330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "582 E BROWNING AVE",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841052025",
            "telephone_number": "650-619-8618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 MERRITT BLVD",
            "address_2": "SUITE 106",
            "city": "FISHKILL",
            "state": "NY",
            "postal_code": "125242990",
            "telephone_number": "845-905-5090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIBLE",
        "first_name": "SHANE",
        "middle_name": "MARTIN",
        "credential": "MPAS, PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-28",
        "last_updated": "2013-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "6792106-1206",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "PA2013-0029",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Weisberger
• Susan Weisel, MD
• Michael A. Westerman, PHD
• Jayde Taylor Whelan
• Forrest Nelson White, M.D.
• Catherine Williams, PSY.D.
• Dorothy Wilson
• Jennifer Wilson, P.A.
• Wingate of Dutchess, Inc. (Wingate at Dutchess)
• Katelynn Bond Worobey, CF-SLP

• Physician Assistant in Fishkill, NY
• Providers in Fishkill, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.