Active NPI
Shade R Whalen, MD
- Pediatrics Physician
- Hastings, NE
National Provider Identifier
1013929876
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 23753
- Practice address
- 2115 N Kansas
Children & Adolescent Clinic PC
Hastings, NE 68901 - Phone
- (402) 463-6828
- Fax
- (402) 463-4767
- NPI assigned
- Aug 12, 2006
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 23753 | NE | Primary |
Addresses
Primary practice location
2115 N Kansas
Children & Adolescent Clinic PC
Hastings, NE 68901
Mailing address
2115 N Kansas
Children & Adolescent Clinic PC
Hastings, NE 68901
Phone (402) 463-6828
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 47063717813 | Medicaid | NE |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23753 | NE | MD | Pediatrics Physician |
Interoperability endpoints
- shade@caacclinic.directbygreenway.com
- swhalen180560@direct.nebraskamed.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326931200000",
"number": "1013929876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2115 N KANSAS",
"address_2": "CHILDREN & ADOLESCENT CLINIC PC",
"city": "HASTINGS",
"state": "NE",
"postal_code": "68901",
"telephone_number": "402-463-6828",
"fax_number": "402-463-4767"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2115 N KANSAS",
"address_2": "CHILDREN & ADOLESCENT CLINIC PC",
"city": "HASTINGS",
"state": "NE",
"postal_code": "68901",
"telephone_number": "402-463-6828",
"fax_number": "402-463-4767"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHALEN",
"first_name": "SHADE",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-12",
"last_updated": "2012-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NE",
"license": "23753",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47063717813",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hastings, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.