Active NPI
Michael N Shaw, PA
- Medical Physician Assistant
- Wichita, KS
National Provider Identifier
1063482917
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 15-00115
- Practice address
- 2600 N Woodlawn St
Wichita, KS 67220-2729 - Phone
- (316) 684-3838
- Fax
- (316) 858-2521
- NPI assigned
- Jan 24, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 15-00115 | KS | Primary |
Addresses
Primary practice location
2600 N Woodlawn St
Wichita, KS 67220-2729
Mailing address
2600 N Woodlawn St
Wichita, KS 67220-2729
Phone (316) 684-3838
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100004660C | Medicaid | KS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Yes, effective Apr 1, 2022 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Galichia Medical Group, P.a. | Past | Accepting new patients | |
| Renovo Medical LLC | Past | Accepting new patients | |
| Pawnee Valley Community Hospital Inc | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Cardiovascular Disease Physician
- Wichita, KS
- NPI 1447238621
-
dba Pawnee Valley Community Hospital Family Medicine
- General Practice Physician
- Larned, KS
- NPI 1912310822
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442448000000",
"number": "1063482917",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2600 N WOODLAWN ST",
"city": "WICHITA",
"state": "KS",
"postal_code": "672202729",
"telephone_number": "316-684-3838",
"fax_number": "316-858-2521"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2600 N WOODLAWN ST",
"city": "WICHITA",
"state": "KS",
"postal_code": "672202729",
"telephone_number": "316-684-3838",
"fax_number": "316-858-2521"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "MICHAEL",
"middle_name": "N",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-24",
"last_updated": "2015-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "KS",
"license": "15-00115",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100004660C",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wichita, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2015; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.