Elena Suzanne Shea, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

41858 Issued in AZ

Practice address

450 S Willard St Ste 103
Cottonwood, AZ 86326-6744

Phone

(928) 634-9573

Fax

(928) 634-0135

NPI assigned

Feb 12, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Prescott Healthcare Solutions LLC

  dba Optima Medical

  • Family Medicine Physician
  • Prescott, AZ
  • NPI 1821454505
  Medicare reassignment NPD
• Omega Orthopaedics, Inc

  • Orthopaedic Trauma Physician
  • Cottonwood, AZ
  • NPI 1881810844
  NPD (past)

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673395200000",
    "number": "1023150794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 S WILLARD ST STE 103",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863266744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 S WILLARD ST STE 103",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863266744",
            "telephone_number": "928-634-9573",
            "fax_number": "928-634-0135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEA",
        "first_name": "ELENA",
        "middle_name": "SUZANNE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-12",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "J4510",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "41858",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "136239",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Seth Arnall DMD PLLC (Verde River Dental)
• Sabitha Sheela Setty, M.D.
• Ahmed Shah, M.D.
• Jacob D. Shank, M.D.
• Janet Elizabeth Shannon, LPC
• Stephanie Marie Shilling, C.N.M.
• David Clark Shillington, MD
• Isabelle Shook, LPC
• Angela Joy Siatta, RN
• Jugraj Singh, M.D.

• Family Medicine Physician in Cottonwood, AZ
• Providers in Cottonwood, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.