Individual provider Active NPI

Matthew Guy Shook, DPM

  • Podiatrist
  • Portland, OR
National Provider Identifier
1083280192
Registry record updated Jun 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
DP224665 Issued in OR
Practice address
1015 NW 22ND Ave
Portland, OR 97210-3025
Phone
(503) 413-8401
Fax
(503) 413-7361
NPI assigned
May 29, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 27, 2025

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 AZ
Podiatrist 213E00000X DP224665 OR Primary

Addresses

Primary practice location

1015 NW 22ND Ave
Portland, OR 97210-3025

Mailing address

1015 NW 22ND Ave
Portland, OR 97210-3025
Phone (503) 413-8401

Other practice location 1

19555 N 59th Ave
Glendale, AZ 85308-6813
Phone (623) 572-3447

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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

Enrollment IDStateProvider typePAC IDDetails
I20250711001531 OR Practitioner - Podiatry 6901283480 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Arizona College of Osteopathic Medicine Mid Western University, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Clinics LLCGroup PAC ID 0244144004, 714 clinicians

Practice addresses (Care Compare)

2800 N Vancouver Ave
Suite 118
Portland, OR 97227-1643
Phone (503) 413-4992

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Clinics LLC CurrentSince Jun 24, 2025 Accepting new patients
Legacy Clinics LLC Past Accepting new patients

Locations

1015 NW 22nd Ave
Portland, OR 97210
Phone (503) 413-7582

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

2800 N Vancouver Ave
Ste 118
Portland, OR 97227
Phone (503) 249-8851

1919 NW Lovejoy St
Portland, OR 97209
Phone (503) 415-5600

19250 SW 65th Ave
Ste 200
Tualatin, OR 97062
Phone (503) 413-2005

Organizations & group practices 2

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 4

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": "1622246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750982400000",
    "number": "1083280192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 NW 22ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103025",
            "telephone_number": "503-413-8401",
            "fax_number": "503-413-7261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 NW 22ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103025",
            "telephone_number": "503-413-8401",
            "fax_number": "503-413-7361"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19555 N 59th Ave",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "853086813",
            "country_code": "US",
            "telephone_number": "623-572-3447",
            "fax_number": "623-572-3449",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHOOK",
        "first_name": "MATTHEW",
        "middle_name": "GUY",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-05-29",
        "last_updated": "2025-06-27",
        "certification_date": "2025-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "AZ",
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "OR",
            "license": "DP224665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.