Ronald Dean Shore II, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

56824 Issued in CA

Practice address

1701 W Superior St
Chicago, IL 60622-5646

Phone

(312) 666-3494

NPI assigned

Apr 1, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL, CA, NC3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Physician Assistant

Education

Emory University School of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Charlotte Community Health Clinic, Inc.Group PAC ID 0840502274, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rshore1652051@direct.novanthealth.org

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.

• Charlotte Community Health Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Charlotte, NC
  • NPI 1528363868
  Medicare reassignment Care Compare group NPD (past)
• Access Community Health Network

  • Federally Qualified Health Center (FQHC)
  • Des Plaines, IL
  • NPI 1982783692
  Medicare reassignment
• Erie Family Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1760499545
  Medicare reassignment
• Family Health Centers of San Diego, Inc

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1447281936
  Medicare reassignment
• Access Community Health Network

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1699701383
  NPD
• Access Community Health Network

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1780754523
  NPD
• Erie Family Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1548062318
  NPD
• Erie Family Health Center Inc.

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1215228192
  NPD
• Charlotte Community Health Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Charlotte, NC
  • NPI 1902251275
  NPD
• Family Health Centers of San Diego Inc

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1235521782
  NPD
• Family Health Centers of San Diego, Inc

  • Federally Qualified Health Center (FQHC)
  • Escondido, CA
  • NPI 1356178180
  NPD

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

{
    "created_epoch": "1364774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735257600000",
    "number": "1083957740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 W SUPERIOR ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606225646",
            "telephone_number": "312-666-3494",
            "fax_number": "312-666-6228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 W SUPERIOR ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606225646",
            "telephone_number": "312-666-3494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORE",
        "first_name": "RONALD",
        "middle_name": "DEAN",
        "name_suffix": "II",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-01",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085004625",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "56824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alison M Shore, MD
• David Michael Shore, M.D.
• Jeffrey Joseph Shore, MSW LCSW
• Julia C Shore, APRN, CNP
• Richard M. Shore, MD
• Shoreland Optical Co #27 Inc.
• Shoreline Behavioral of Illinois, Professional LLC
• Shoreline Logistics
• Shoreline Medical Equipment,LLC
• Janiece Shores

• Physician Assistant in Chicago, IL
• Providers in Chicago, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2024; 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.