Maverik Nicholas Shumway

Primary specialty

OptometristTaxonomy code 152W00000X

License

13396974-8908 Issued in UT

Practice address

910 S 300 W
Blanding, UT 84511-3921

Phone

(435) 678-0590

NPI assigned

Apr 3, 2023

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

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Southern College of Optometry, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Utah Navajo Health System IncorporatedGroup PAC ID 1658275649, 47 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• UT PPO
• UT PPO D-SNP

Interoperability endpoints

• Direct secure messaging: maverik.shumway.1@16098.direct.athenahealth.com

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.

• Utah Navajo Health System, Incorporated

  dba Montezuma Creek Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Montezuma Creek, UT
  • NPI 1811991151
  Medicare reassignment Care Compare group NPD
• Utah Navajo Health System, Incorporated

  dba Blanding Family Practice Community Health Center

  • Family Medicine Physician
  • Blanding, UT
  • NPI 1457489486
  NPD (past)
• Utah Navajo Health System, Incorporated

  • Land Ambulance
  • Montezuma Creek, UT
  • NPI 1598198434
  NPD (past)

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

{
    "created_epoch": "1680480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684195200000",
    "number": "1063117893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 N BLUE MOUNTAIN RD",
            "city": "BLANDING",
            "state": "UT",
            "postal_code": "845112012",
            "telephone_number": "435-459-1923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 S 300 W",
            "city": "BLANDING",
            "state": "UT",
            "postal_code": "845113921",
            "telephone_number": "435-678-0590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUMWAY",
        "first_name": "MAVERIK",
        "middle_name": "NICHOLAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-03",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "13396974-8908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Seweingyawma
• Dominique Sherrow
• Shauna Sherrow
• Cortney Anne Shumway
• Grady Shumway
• Samantha Spillman
• Sterling Black, LLC (San Juan Chiropractic & Wellness Center)
• Tangle Water Non Emergency Medical Transportation
• Taylor G Wright, PC (Innovation Medical Group)
• Laura L Timmerman, M.P.T.

• Optometrist in Blanding, UT
• Providers in Blanding, UT by specialty
• Optometrist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.