Samuel Teagan Shaw, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

73570 Issued in ID

Practice address

1835 Harrison St N Unit 16104
Twin Falls, ID 83301-4294

Phone

(208) 431-3570

NPI assigned

Jul 18, 2022

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 ID

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sterling Provider GroupGroup PAC ID 2264773373, 52 clinicians

Innovative Medical Imaging PLLCGroup PAC ID 1951711050, 23 clinicians

Innovative Family Medicine of Idaho PLLCGroup PAC ID 2668820556, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Innovative Medical Imaging, PLLC

  • Diagnostic Radiology Physician
  • Twin Falls, ID
  • NPI 1962015776

  Diagnostic Radiology, ID

  Medicare reassignment Care Compare group NPD
• Sterling Provider Group

  • Urgent Care Clinic/Center
  • Idaho Falls, ID
  • NPI 1205300407

  ID

  Medicare reassignment Care Compare group NPD
• Innovative Family Medicine of Idaho PLLC

  • Family Medicine Physician
  • Twin Falls, ID
  • NPI 1811689870

  ID

  Medicare reassignment Care Compare group
• North Canyon Medical Center Inc.

  • Critical Access Hospital
  • Gooding, ID
  • NPI 1609046671

  ID

  Medicare reassignment
• North Canyon Medical Center, Inc.

  • Radiology Clinic/Center
  • Twin Falls, ID
  • NPI 1700641636

  ID

  Medicare reassignment
• Sterling Provider Group

  • Rural Health Clinic/Center
  • Rexburg, ID
  • NPI 1407564123
  Care Compare group
• Sterling Provider Group

  • Rural Health Clinic/Center
  • Chubbuck, ID
  • NPI 1477200244
  Care Compare group
• Sterling Provider Group

  • Rural Health Clinic/Center
  • Burley, ID
  • NPI 1659915593
  Care Compare group
• Sterling Provider Group

  • Rural Health Clinic/Center
  • Hailey, ID
  • NPI 1912541863
  Care Compare group
• Sterling Provider Group

  • Rural Health Clinic/Center
  • Idaho Falls, ID
  • NPI 1952923765
  Care Compare group
• Sterling Provider Group

  • Rural Health Clinic/Center
  • Evanston, WY
  • NPI 1164044962
  Care Compare group
• Sterling Provider Group

  • Rural Health Clinic/Center
  • Richmond, UT
  • NPI 1164066015
  Care Compare group

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

{
    "created_epoch": "1658102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658188800000",
    "number": "1073248787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1835 HARRISON ST N UNIT 16104",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833014294",
            "telephone_number": "208-431-3570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1835 HARRISON ST N UNIT 16104",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833014294",
            "telephone_number": "208-431-3570"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1039 Blake St N",
            "address_purpose": "LOCATION",
            "city": "Twin Falls",
            "state": "ID",
            "postal_code": "833013108",
            "country_code": "US",
            "telephone_number": "208-431-3570",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAW",
        "first_name": "SAMUEL",
        "middle_name": "TEAGAN",
        "name_prefix": "Mr.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-18",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "73570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• SH1 Midstate MGMT LLC
• Heather Shaw
• Kory Lynn Shaw, OD
• Kylee Shaw, PA
• Michael Shaw, DO
• Thomas Domingo Shaw, P.T.
• Stephanie Ann Shawver, AGACNP-BC
• Idris Jamal Shelby
• Joyce Irene Shetler, LCSW
• Ynez Shetler

• All providers in Twin Falls, ID
• Family Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2022; 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.