NPIMap

Individual provider Active NPI

Jamal Shillingford

  • Orthopaedic Surgery of the Spine Physician
  • Larkspur, CA
National Provider Identifier
1063855567
Registry record updated Aug 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X
License
51177 Issued in KY
Practice address
2 Bon Air Rd Ste 120
Larkspur, CA 94939-1142
Phone
(415) 927-5300
NPI assigned
Apr 15, 2013
Last updated
Aug 20, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2019

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
Orthopaedic Surgery of the Spine Physician 207XS0117X 51177 KY Primary

Addresses

Primary practice location

2 Bon Air Rd Ste 120
Larkspur, CA 94939-1142

Mailing address

PO Box 776351
Chicago, IL 60677-6351
Phone (502) 272-5063

Other practice location 1

630 W 168th St
New York, NY 10032-3725
Phone (212) 305-2862

Other practice location 2

550 S Jackson St
Louisville, KY 40202-1622
Phone (502) 587-7140

Other practice location 3

210 E Gray St Ste 900
Louisville, KY 40202
Phone (502) 584-7525

Other identifiers 1

IdentifierTypeStateIssuer
300013826MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address info@caorthospine.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180516001497 KY Practitioner - Orthopedic Surgery 5193089365 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Columbia University College of Physicians and Surgeons, 2013
Medicare assignment
May accept Medicare assignment
Group practices
Joseph Laratta MD Spine Surgeon LLCGroup PAC ID 7517398936, 2 clinicians
New Horizons Physical Therapy Limited PartnershipGroup PAC ID 4183641608, 77 clinicians

Practice addresses (Care Compare)

1623 S Preston St
Suite 100
Louisville, KY 40217-1038
Phone (502) 413-5777

2125 State St
New Albany, IN 47150-4972

743 E Broadway
Suite 171
Louisville, KY 40202-1711

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion237
Laminectomy or laminotomy (partial removal of spine bones)66

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Joseph Laratta MD Spine Surgeon, LLC Orthopaedic Surgery of the Spine CurrentSince May 1, 2022 Accepting new patients
Community Medical Associates, Inc. Current Accepting new patients
University of Louisville Physicians, Inc. CurrentSince Jul 1, 2018 Accepting new patients
University of Louisville Physicians, Inc. CurrentSince Jul 1, 2018 Accepting new patients
Community Medical Associates, Inc. CurrentSince Jul 23, 2018 Accepting new patients
Community Medical Associates, Inc. CurrentSince Jul 23, 2018 Accepting new patients
Uofl Health-Louisville Inc Past Accepting new patients

Locations

7752 Solution Ctr
Chicago, IL 60677

1101 Professional Blvd
Evansville, IN 47714
Phone 81247772461041

1169 Eastern Pkwy
Ste 400
Louisville, KY 40217
Phone (502) 276-5554

1623 S Preston St
Ste 100
Louisville, KY 40217
Phone (502) 413-5777

170 Dr Arla Way
Louisville, KY 40229
Phone (502) 585-4376

210 E Gray St
Ste 900
Louisville, KY 40202
Phone (502) 584-8002

530 S Jackson St
Louisville, KY 40202
Phone (502) 562-3000

550 S Jackson St
Louisville, KY 40202
Phone (502) 561-8686

571 S Floyd St
Louisville, KY 40202
Phone (502) 561-2700

743 E Broadway
Louisville, KY 40202
Phone (502) 509-9436

825 Barret Ave
Louisville, KY 40204
Phone (502) 272-5165

8442 Dixie Hwy
Louisville, KY 40258
Phone (502) 286-4644

Interoperability endpoints

  • Direct secure messaging: info@caorthospine.com

Organizations & group practices 8

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.

Hospital & facility affiliations 41

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 41

NPI Registry JSON

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

{
    "created_epoch": "1365984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566259200000",
    "number": "1063855567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776351",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776351",
            "telephone_number": "502-272-5063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 BON AIR RD STE 120",
            "city": "LARKSPUR",
            "state": "CA",
            "postal_code": "949391142",
            "telephone_number": "415-927-5300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "630 W 168th St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100323725",
            "country_code": "US",
            "telephone_number": "212-305-2862",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "550 S Jackson St",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402021622",
            "country_code": "US",
            "telephone_number": "502-587-7140",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "210 E Gray St Ste 900",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "40202",
            "country_code": "US",
            "telephone_number": "502-584-7525",
            "fax_number": "502-584-6851",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHILLINGFORD",
        "first_name": "JAMAL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-15",
        "last_updated": "2019-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "KY",
            "license": "51177",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300013826",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@caorthospine.com",
            "affiliation": "N",
            "address_1": "2 Bon Air Rd Ste 120",
            "city": "Larkspur",
            "state": "CA",
            "country_code": "US",
            "postal_code": "949391142",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Larkspur, CA

Sources for this page

Verify at the official NPI Registry.