Active NPI
Matthew Guy Shook, DPM
- Podiatrist
- Portland, OR
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- DP224665
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
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
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
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Legacy Clinics LLC | Current | 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.
-
- Clinic/Center
- Portland, OR
- NPI 1902827272
-
dba Legacy Medical Group Firwood
- Rural Health Clinic/Center
- Sandy, OR
- NPI 1730472192
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Unity Center for Behavioral Health-PES
- General Acute Care Hospital
- Portland, OR
- NPI 1003367491
-
dba Legacy Laboratory Services
- Clinical Medical Laboratory
- Portland, OR
- NPI 1295756898
Hospital
-
- General Acute Care Hospital
- Portland, OR
- NPI 1831112358
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2025; 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.