Marcey Ellen Shapiro, MD
Individual provider Active NPI Family Medicine Physician · Embudo, NM
NPI 1033283080 · NPPES record last updated Sep 7, 2023
Key facts
- NPI
- 1033283080
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- G083515 (CA)
- Practice address
- 16 Private Drive 1103
Embudo, NM 87531 - Phone
- (510) 525-2200
- Fax
- (510) 526-9648
- NPI assigned
- Nov 20, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
- Opted out of Medicare
- Yes, effective Aug 3, 2015 through Aug 3, 2027
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 83515 | CA | MD | Dental Assistant |
| G083515 | CA | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | G083515 | CA | Yes |
Addresses
Primary practice location
16 Private Drive 1103
Embudo, NM 87531
Mailing address
PO Box 247
Embudo, NM 87531-0247
Phone (510) 525-2200
Other practice location 1
3515 Grand Ave
Oakland, CA 94610-2037
Phone (510) 525-2200
Other providers in Embudo, NM
All providers in Embudo, NM · Family Medicine Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.