Cullen Richard Shanrock, DPM
Individual provider Active NPI Foot & Ankle Surgery Podiatrist · Woodruff, WI
NPI 1083298673 · NPPES record last updated Oct 1, 2024
Key facts
- NPI
- 1083298673
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Foot & Ankle Surgery Podiatrist 213ES0103X
- License
- 1339-25 (WI)
- Practice address
- 311 Elm St
Woodruff, WI 54568-9149 - Phone
- (651) 564-2094
- NPI assigned
- May 10, 2021
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 12
Medicare Care Compare profile
- Specialty
- Podiatry
- Education
- New York College of Podiatric Medicine, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Lac Du Flambeau Band of Lake Superior Chippewa Indians
Sokaogon Chippewa Community
Red Cliff Band of Lake Superior Chippewa Indians
Bad River Band of Lake Superior Tribe of Chippewa Indians Wis
Forest County Potawatomi Community
Lac Courte Oreilles Governing Board
Lac Vieux Desert Band of Lake Superior Chippewa Indians
Practice addresses (Care Compare)
129 Old Abe Rd
Lac Du Flambeau, WI 54538-9386
Phone (715) 588-3371
3144 Vanzile Rd
Crandon, WI 54520-8149
Phone (715) 478-5180
36745 Aiken Rd
Bayfield, WI 54814-4579
Phone 71577937072324
53585 Nokomis Rd
Ashland, WI 54806-4272
Phone (715) 682-7133
8201 Mish Ko Swen Dr
Crandon, WI 54520-8631
Phone (715) 478-4300
9940 N County Hwy K
Hayward, WI 54843-4277
Phone (715) 638-5100
N5241 US Hwy
Watersmeet, MI 49969-0009
Phone (906) 358-4588
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 18 |
| Removal of nail tissue | 98 |
| Removal or shaving of skin growth | 37 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241118004150 | TX | Practitioner - Podiatry | 8022543735 | Reassigns benefits to 2 organizations |
| I20241120000560 | WI | Practitioner - Podiatry | 8022543735 | Reassigns benefits to 5 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Red Cliff Band of Lake Superior Chippewa Indians | Current |
Accepting new patients | |
| Lac Vieux Desert Band of Lake Superior Chippewa Indians | Current |
Accepting new patients | |
| Lac Du Flambeau Band of Lake Superior Chippewa Indians | Current |
Accepting new patients | |
| Bad River Band of Lake Superior Tribe of Chippewa Indians Wis | Current |
Accepting new patients | |
| Bad River Band of Lake Superior Tribe of Chippewa Indians Wis. | Current |
Accepting new patients | |
| Forest County Potawatomi Community | Foot & Ankle Surgery | Current |
Accepting new patients |
| Red Cliff Band of Lake Superior Chippewa Indians | Current |
Accepting new patients | |
| Lac Du Flambeau Band of Lake Superior Chippewa Indians | Current |
Accepting new patients | |
| Sokaogon Chippewa Community | Current |
Accepting new patients | |
| Lac Courte Oreilles Governing | Current |
Accepting new patients | |
| Forest County Potawatomi Health & Wellness Center | Current |
Accepting new patients | |
| Comprehensive Foot & Ankle, SC | Past |
Accepting new patients |
Locations
N5241 US Highway 45
Watersmeet, MI 49969
Phone (906) 358-4587
53585 Nokomis Rd
Ashland, WI 54806
Phone (715) 682-7133
36745 Aiken Rd
Bayfield, WI 54814
Phone (715) 779-3707
3144 Vanzile Rd
Crandon, WI 54520
Phone (715) 478-5180
8201 Mish Ko Swen Dr
Crandon, WI 54520
Phone (715) 478-4300
9940N County Road K
Hayward, WI 54843
Phone (715) 638-5100
129 Old Abe Rd
Lac du Flambu, WI 54538
Phone (715) 588-3371
Interoperability endpoints
- https://api.platform.athenahealth.com/8439/brand/1/csg/21/fhir/r4
- https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.73753
- cullen.shanrock.1@8439.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 1339-25 | WI | Yes |
Addresses
Primary practice location
311 Elm St
Woodruff, WI 54568-9149
Mailing address
7428 Loon Landing SHRS
Lake Tomahawk, WI 54539-9110
Phone (651) 564-2094
Other providers in Woodruff, WI
- William E Schulte
- Elizabeth A Schussler
- Cheryl J Sell
- David J Sell
- Christy Jo Semmerling
- William Albert Shope
- Amy J Slone
- Louis Voigt Smith Jr.
- John Stapelman
- Jeanne M. Sykora
All providers in Woodruff, WI · Foot & Ankle Surgery Podiatrist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.