Individual provider Active NPI

Kareen Shebaclo, MD

  • Ophthalmology Physician
  • Philadelphia, PA
National Provider Identifier
1063935542
Registry record updated Oct 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
ME176400 Issued in FL
Practice address
840 Walnut St Ste 910
Philadelphia, PA 19107-5109
Phone
(215) 928-3250
Fax
(215) 928-3276
NPI assigned
Jul 17, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmic Plastic and Reconstructive Surgery Physician 207WX0200X MD478276 PA
Ophthalmology Physician 207W00000X ME176400 FL Primary
Ophthalmology Physician 207W00000X MD478276 PA

Addresses

Primary practice location

840 Walnut St Ste 910
Philadelphia, PA 19107-5109

Mailing address

840 Walnut St Ste 910
Philadelphia, PA 19107-5109
Phone (215) 928-3250

Other practice location 1

4500 San Pablo Rd S
Jacksonville, FL 32224-1865
Phone (904) 953-2000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kshebaclo2560148@ehrdirect.mayoclinicmsg.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ, FL3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20220622000017 PA Practitioner - Ophthalmology 3375922321 Reassigns benefits to 2 organizations
I20250624000348 NJ Practitioner - Ophthalmology 3375922321 Reassigns benefits to 1 organization
I20250925004268 FL Practitioner - Ophthalmology 3375922321 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Georgetown University School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mayo Clinic JacksonvilleGroup PAC ID 5698689297, 1,595 clinicians

Practice addresses (Care Compare)

4500 San Pablo Rd S
Jacksonville, FL 32224-1865
Phone (904) 953-2000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.89 of 100Reported as group
Quality
95.81
Promoting interoperability
94
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
87.34 of 100Reported as group
Quality
80.85
Promoting interoperability
100
Improvement activities
40
Cost
76.95

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision11
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD478276PAMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Jacksonville CurrentSince Sep 15, 2025 Accepting new patients
Annesley Flanagan Fischer Stefanyszyn and Associates Ophthalmology CurrentSince Nov 1, 2024 Accepting new patients
Wills Eye Ophthalmology Clinic, Inc Ophthalmology CurrentSince Jul 1, 2022 Accepting new patients
Mayo Clinic Jacksonville CurrentSince Sep 15, 2025 Accepting new patients
Edmonds & Associates LLC Past Accepting new patients

Locations

4500 San Pablo Rd S
Jacksonville, FL 32224
Phone (904) 721-4815

775 Route 70 E
Marlton, NJ 08053
Phone (856) 596-1601

775 Route 70 E
Ste F180
Marlton, NJ 08053
Phone (856) 596-1601

840 Walnut St
Ste 1230
Philadelphia, PA 19107
Phone (215) 440-3160

840 Walnut St
Ste 910
Philadelphia, PA 19107
Phone (215) 928-3250

100 E Lancaster Ave
Ste 54
Wynnewood, PA 19096
Phone (610) 645-3337

54 Lankenau Medical Building E
Wynnewood, PA 19096

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • FHIR API: https://fhir4.healow.com/fhir/r4/EDBFBA

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1500249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759276800000",
    "number": "1063935542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 WALNUT ST STE 910",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075109",
            "telephone_number": "215-928-3250",
            "fax_number": "215-928-3276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 WALNUT ST STE 910",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075109",
            "telephone_number": "215-928-3250",
            "fax_number": "215-928-3276"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4500 San Pablo Rd S",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322241865",
            "country_code": "US",
            "telephone_number": "904-953-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHEBACLO",
        "first_name": "KAREEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-17",
        "last_updated": "2025-10-01",
        "certification_date": "2025-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207WX0200X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery",
            "state": "PA",
            "license": "MD478276",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "ME176400",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "PA",
            "license": "MD478276",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kshebaclo2560148@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "4500 San Pablo Rd S",
            "city": "Jacksonville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "322241865",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.