NPIMap

Organization Active NPI

Shenandoah Emergency Medicine Specialists LLC

  • Emergency Medicine Physician
  • Fishersville, VA
National Provider Identifier
1083706121
Registry record updated Jun 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
SHENANDOAH EMERGENCY MEDICINE SPECIALISTS LLC
Practice address
78 Medical Drive
Fishersville, VA 22939-1000
Phone
(540) 332-4423
Fax
(540) 332-5658
NPI assigned
Sep 28, 2006
Last updated
Jun 18, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2015

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

Authorized official

Name
Glen E Michael, MDNPI 1407052210
Title
Cfo
Phone
(540) 332-4423

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

78 Medical Drive
Fishersville, VA 22939-1000

Mailing address

PO Box 11107
Daytona Beach, FL 32120-1107
Phone (888) 311-8760

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070306000507 VA Part B Supplier - Clinic/Group Practice 0345343620 Receives reassigned benefits from 57 practitioners
Practice locations: Fishersville, VA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 61

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 61

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434585600000",
    "number": "1083706121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11107",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321201107",
            "telephone_number": "888-311-8760",
            "fax_number": "386-274-7819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78 MEDICAL DRIVE",
            "city": "FISHERSVILLE",
            "state": "VA",
            "postal_code": "229391000",
            "telephone_number": "540-332-4423",
            "fax_number": "540-332-5658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHENANDOAH EMERGENCY MEDICINE SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2015-06-18",
        "status": "A",
        "authorized_official_last_name": "MICHAEL",
        "authorized_official_first_name": "GLEN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "540-332-4423",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fishersville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.