Individual provider Active NPI

Brian E. O'Shaughnessy, MD

  • Neurology Physician
  • Waterloo, IA
National Provider Identifier
1023021151
Registry record updated Mar 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
036-066709 Issued in IL
Practice address
152 W Dale St
Waterloo, IA 50703-1925
Phone
(319) 235-5060
Fax
(319) 235-5061
NPI assigned
Aug 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 036-066709 IL Primary

Addresses

Primary practice location

152 W Dale St
Waterloo, IA 50703-1925

Mailing address

152 W Dale St
Waterloo, IA 50703-1925
Phone (319) 235-5060

Other identifiers 1

IdentifierTypeStateIssuer
036066709MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160513000250 IA Practitioner - Neurology 6901826684 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

152 W Dale St
Waterloo, IA 50703-1925
Phone (319) 235-5060

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036-066709ILMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Iowa Physicians Clinic Medical Foundation Neurology CurrentSince May 2, 2016 Accepting new patients
St Luke'S Methodist Hospital Current Accepting new patients
Floyd County Memorial Hospital Commission Past Accepting new patients

Locations

4480 Utica Ridge Rd
Ste 160
Bettendorf, IA 52722
Phone (563) 742-5950

4480 Utica Ridge Rd
Ste 2230
Bettendorf, IA 52722
Phone (563) 742-5150

8101 Birchwood Ct
Unit R
Urbandale, IA 50131
Phone (515) 471-9363

2140 Logan Ave
Ste B
Waterloo, IA 50703
Phone (319) 226-8470

152 W Dale St
Waterloo, IA 50703
Phone (319) 235-3540

1825 Logan Ave
Waterloo, IA 50703
Phone (319) 235-3886

Interoperability endpoints

  • Direct secure messaging: boshaughnessy386696@direct.unitypoint.org

Organizations & group practices 3

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

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": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458777600000",
    "number": "1023021151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "152 W DALE ST",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507031925",
            "telephone_number": "319-235-5060",
            "fax_number": "319-235-5061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "152 W DALE ST",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507031925",
            "telephone_number": "319-235-5060",
            "fax_number": "319-235-5061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'SHAUGHNESSY",
        "first_name": "BRIAN",
        "middle_name": "E.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-13",
        "last_updated": "2016-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IL",
            "license": "036-066709",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036066709",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, IA

Sources for this page

Verify at the official NPI Registry.