Active NPI
Marty W Shields, M.D.
- Family Medicine Physician
- Miramar, FL
National Provider Identifier
1053469361
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- H0814
- Practice address
- 3601 SW 160TH Ave
Suite 250
Miramar, FL 33027-6308 - Phone
- (954) 399-4645
- Fax
- (855) 855-2792
- NPI assigned
- Jan 5, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular Surgery Physician | 2086S0129X | H 0814 | TX | |
| Surgery Physician | 208600000X | H0814 | TX | |
| Family Medicine Physician | 207Q00000X | H0814 | TX | Primary |
Addresses
Primary practice location
3601 SW 160TH Ave
Suite 250
Miramar, FL 33027-6308
Mailing address
1400 Wallace Blvd
Attn: Credentialing
Amarillo, TX 79106-1708
Phone (806) 354-5585
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 038142802 | Medicaid | TX | |
| 47924772 | Medicaid | NM | |
| PO80T6168 | Medicaid | TX | |
| 200234310 A | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| H 0814 | TX | MD | Vascular Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476230400000",
"number": "1053469361",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 WALLACE BLVD",
"address_2": "ATTN: CREDENTIALING",
"city": "AMARILLO",
"state": "TX",
"postal_code": "791061708",
"telephone_number": "806-354-5585",
"fax_number": "806-356-4673"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3601 SW 160TH AVE",
"address_2": "SUITE 250",
"city": "MIRAMAR",
"state": "FL",
"postal_code": "330276308",
"telephone_number": "954-399-4645",
"fax_number": "855-855-2792"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIELDS",
"first_name": "MARTY",
"middle_name": "W",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-05",
"last_updated": "2016-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "TX",
"license": "H 0814",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "TX",
"license": "H0814",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "H0814",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "038142802",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47924772",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PO80T6168",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200234310 A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Miramar, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.