Individual provider Active NPI

Shelby Glynn Stockton

  • Medical Physician Assistant
  • Rostraver Township, PA
National Provider Identifier
1043957582
Registry record updated Nov 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
MA063933 Issued in PA
Practice address
800 Plaza Dr Ste 140
Rostraver Township, PA 15012-4019
Phone
(724) 929-4122
NPI assigned
May 17, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Medical Physician Assistant 363AM0700X MA063933 PA Primary

Addresses

Primary practice location

800 Plaza Dr Ste 140
Rostraver Township, PA 15012-4019

Mailing address

22521 Sportsman Rd
Spartansburg, PA 16434-3343
Phone (412) 584-0730

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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

Enrollment IDStateProvider typePAC IDDetails
I20230315000863 PA Practitioner - Physician Assistant 9335513399 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mon-Vale Specialty Practices, IncGroup PAC ID 0042464026, 17 clinicians

Practice addresses (Care Compare)

1163 Country Club Rd
Monongahela, PA 15063-1013

Hospital & facility affiliations

  • Penn Highlands Mon Valley Hospital, Monongahela, PA, CCN 390147

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mon-Vale Specialty Practices, Inc CurrentSince Oct 27, 2022 Accepting new patients
Mon-Vale Specialty Practices, Inc CurrentSince Oct 27, 2022 Accepting new patients

Locations

100 Hospital Ave
Dubois, PA 15801
Phone (814) 375-2040

1163 Country Club Rd
Monongahela, PA 15063
Phone (724) 258-1000

800 Plaza Dr
Ste 140
Rostraver Township, PA 15012
Phone (724) 379-5802

Organizations & group practices 2

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 3

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": "1652745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668902400000",
    "number": "1043957582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22521 SPORTSMAN RD",
            "city": "SPARTANSBURG",
            "state": "PA",
            "postal_code": "164343343",
            "telephone_number": "412-584-0730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 PLAZA DR STE 140",
            "city": "ROSTRAVER TOWNSHIP",
            "state": "PA",
            "postal_code": "150124019",
            "telephone_number": "724-929-4122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOCKTON",
        "first_name": "SHELBY",
        "middle_name": "GLYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-17",
        "last_updated": "2022-11-20",
        "certification_date": "2022-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA063933",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rostraver Township, PA

Sources for this page

Verify at the official NPI Registry.