Shane H Peng, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0101055813 Issued in VA

Practice address

400 Sentara Cir
Ste 450
Williamsburg, VA 23188-5716

Phone

(757) 345-4614

Fax

(757) 345-4601

NPI assigned

Feb 22, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• SSM Regional Health Services

  dba SSM Health Pharmacy

  • Community/Retail Pharmacy
  • Jefferson City, MO
  • NPI 1922119726
  NPD (past)

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327536000000",
    "number": "1033184130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 SENTARA CIR",
            "address_2": "STE 450",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231885716",
            "telephone_number": "757-345-4614",
            "fax_number": "757-345-4601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 SENTARA CIR",
            "address_2": "STE 450",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231885716",
            "telephone_number": "757-345-4614",
            "fax_number": "757-345-4601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENG",
        "first_name": "SHANE",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2012-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101055813",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010114284",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kylie Pearce
• Pediatric Dental Specialists PLLC
• Kylie Giselle Santos Pelayo-Kim
• Bridget Lue Pelkey Taylor, LM, CPM
• James Bowles Pender
• Peninsula Anesthesia Consultants LLC
• Peninsula Dermatology Skin Cancer Surgery Center, Inc (Dermatology Specialists)
• Peninsula Plastic Surgery Center
• Peninsula Plastic Surgery Center
• Peninsula Plastic Surgery Center-ASC

• Family Medicine Physician in Williamsburg, VA
• Providers in Williamsburg, VA by specialty
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 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.

Verify at the official NPI Registry.