Individual provider Active NPI

Robert Woodworth Shaffer, MD

  • Emergency Medicine Physician
  • Ann Arbor, MI
National Provider Identifier
1083608640
Registry record updated Apr 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
4301074810 Issued in MI
Practice address
1500 East Medical Center Dr
B1 Floor University Hospital Recp Emergency
Ann Arbor, MI 48109-5301
Phone
(734) 936-6666
NPI assigned
Sep 9, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 216959 MA
Emergency Medicine Physician 207P00000X 4301074810 MI Primary

Addresses

Primary practice location

1500 East Medical Center Dr
B1 Floor University Hospital Recp Emergency
Ann Arbor, MI 48109-5301

Mailing address

3621 S State St
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047

Other identifiers 1

IdentifierTypeStateIssuer
2005107MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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 1

Enrollment IDStateProvider typePAC IDDetails
I20081010000260 MI Practitioner - Emergency Medicine 1658332077 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of Michigan Emergency Medicine CurrentSince Jun 24, 2008 Accepting new patients
Regents of the University of Michigan CurrentSince Jun 24, 2008 Accepting new patients
Regents of the University of Michigan Current Accepting new patients

Locations

1500 E Medical Center Dr
#B1
Ann Arbor, MI 48109
Phone (734) 936-4500

3621 S State St
#700
Ann Arbor, MI 48108

1500 E Medical Center Dr
Ann Arbor, MI 48109
Phone (734) 936-4280

1500 E Medical Center Dr
#D
Ann Arbor, MI 48109
Phone (734) 936-5823

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1126224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334793600000",
    "number": "1083608640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "address_2": "700 KMS PLACE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48108",
            "telephone_number": "734-936-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 EAST MEDICAL CENTER DR",
            "address_2": "B1 FLOOR UNIVERSITY HOSPITAL RECP EMERGENCY",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481095301",
            "telephone_number": "734-936-6666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFFER",
        "first_name": "ROBERT",
        "middle_name": "WOODWORTH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-09",
        "last_updated": "2012-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MA",
            "license": "216959",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "4301074810",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2005107",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.