Beverly Shaw, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN207252 Issued in GA

Practice address

1502 W 3Rd St
Jackson, GA 30233-1979

Phone

(770) 914-1808

NPI assigned

Jun 15, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Beverly Jackson Former name

Medicare fee-for-service enrollment

Enrolled in GA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/25178/brand/1/csg/1/fhir/r4

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.

• Southern Primary Care, LLC

  • Internal Medicine Physician
  • Macon, GA
  • NPI 1225551328
  Medicare reassignment NPD
• Southern Primary Care, LLC

  • Clinical Medical Laboratory
  • West Palm Beach, FL
  • NPI 1245111814
  NPD
• Aylo Health, LLC

  • Family Medicine Physician
  • Locust Grove, GA
  • NPI 1710929914
  NPD (past)
• Aylo Health, LLC

  • Sleep Medicine (Family Medicine) Physician
  • Stockbridge, GA
  • NPI 1922831445
  NPD (past)
• First Choice Primary Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Macon, GA
  • NPI 1780480830
  NPD (past)
• First Choice Primary Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Macon, GA
  • NPI 1023492162
  NPD (past)
• First Choice Primary Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Warner Robins, GA
  • NPI 1154747590
  NPD (past)

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

{
    "created_epoch": "1497484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660608000000",
    "number": "1023548591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 RIVERWOOD PKWY SE STE 250",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303393304",
            "telephone_number": "770-914-0116",
            "fax_number": "770-955-4278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 W 3RD ST",
            "city": "JACKSON",
            "state": "GA",
            "postal_code": "302331979",
            "telephone_number": "770-914-1808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "BEVERLY",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-15",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN207252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BEVERLY",
            "last_name": "JACKSON",
            "credential": "FNP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Clyde William Sandford, LPC
• Sanjeeva Rao MD PC
• Select Interventional Pain, PC
• Amir Shaheer
• Shashi Madan MD PC
• Heather Nicole Smith
• Meredith Smith
• South Georgia Treatment, Inc
• Southside Medical Center, Inc.
• Joseph Matt Stewart, LAPC

• Family Nurse Practitioner in Jackson, GA
• Providers in Jackson, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; 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.