Shantise McCall Story, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT002808 Issued in GA

Practice address

2400 Mt. Zion Parkway
Kaiser Permanente Southwood Medical Center
Jonesboro, GA 30236

Phone

(205) 781-5995

NPI assigned

Aug 31, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Shantise Lavette McCall Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AL, GA2 enrollments

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 2

Specialty

Optometry

Education

University Alabama Birmingham - School of Optometry, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Southeast Permanente Medical GroupGroup PAC ID 6204829013, 823 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• The Southeast Permanente Medical Group

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1245266956
  Medicare reassignment Care Compare group NPD
• University of Alabama at Birmingham

  • Internal Medicine Physician
  • Montgomery, AL
  • NPI 1184738478
  Medicare reassignment NPD
• The University of Alabama at Birmingham

  • Optometrist
  • Birmingham, AL
  • NPI 1487677811
  NPD
• University of Alabama at Birmingham

  • General Acute Care Hospital
  • Birmingham, AL
  • NPI 1447145818
  NPD

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

{
    "created_epoch": "1188518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649808000000",
    "number": "1083808174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3495 PIEDMONT ROAD, NE",
            "address_2": "NINE PIEDMONT CENTER",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30305",
            "telephone_number": "404-364-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 MT. ZION PARKWAY",
            "address_2": "KAISER PERMANENTE SOUTHWOOD MEDICAL CENTER",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "30236",
            "telephone_number": "205-781-5995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STORY",
        "first_name": "SHANTISE",
        "middle_name": "MCCALL",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-31",
        "last_updated": "2022-04-13",
        "certification_date": "2022-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AL",
            "license": "SB63TA768",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT002808",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "20 Glenlake Pkwy",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303283473",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SHANTISE",
            "last_name": "MCCALL",
            "middle_name": "LAVETTE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Karen Reneau Stewart, MD
• Olivia Dehavilland Stewart, LPC
• Antionette Stiggers
• Brenda Lee Stinson, LPC
• Sandra E Stoney
• Ashley Renee Stowers, RN
• Amber D.L. Strickland, M.S., CCC-SLP
• Strictly Phlebotomy Atl
• Susan Lynn Strom, RD, LD
• Nicole Renee Studevan, P.T.

• Optometrist in Jonesboro, GA
• Providers in Jonesboro, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2022; 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.

Verify at the official NPI Registry.