Shacelles Shemika Bonner, MD
Individual provider Active NPI Emergency Medicine Physician · New Haven, CT
NPI 1053976894 · NPPES record last updated Jun 29, 2023
Key facts
- NPI
- 1053976894
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 70835 (CT)
- Practice address
- 20 York St
New Haven, CT 06510-3220 - Phone
- (203) 688-4242
- NPI assigned
- May 7, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
Merit-based Incentive Payment System (MIPS)
- Final score
- 90.8 of 100
- Quality
- 91.79
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 75.18
Merit-based Incentive Payment System (MIPS)
- Final score
- 87.36 of 100
- Quality
- 77.36
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 74.27
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240520001608 | NY | Practitioner - Emergency Medicine | 5395072417 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 70835 | CT | MD | Emergency Medicine Physician |
Practice roles (4 of 8)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New York University | Current |
Accepting new patients | |
| New York University | Emergency Medicine | Current |
Accepting new patients |
| Yale University | Emergency Medicine | Current |
Accepting new patients |
| Yale University | Current |
Accepting new patients |
Locations
800 Howard Ave
New Haven, CT 06519
Phone (203) 785-2140
50 Division St
New Haven, CT 06511
Phone (203) 785-2140
20 York St
North Haven, CT 06510
Phone (203) 688-2433
14 Wall St
Fl 9
Wall Street, NY 10005
Phone (646) 501-3224
Networks
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H1722
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Emergency Medicine Physician | 207P00000X | 70835 | CT | Yes |
Addresses
Primary practice location
20 York St
New Haven, CT 06510-3220
Mailing address
20 York St
New Haven, CT 06510-3220
Phone (203) 688-4242
Other providers in New Haven, CT
- Kathryn Bonese
- Brian Adam Bonilla
- Claudia Bonilla
- Yvette Bonilla
- Andrew Bonner
- Elaine K Bonoan
- Travis Daniel Bontrager
- Ya-Ching Carol Bonura
- Eileen Bonyai
- Michelle Bookal
All providers in New Haven, CT · Emergency Medicine Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 29, 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.