Grady D Shaver, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

D9825 Issued in OR

Practice address

73265 Confederated Way
Pendleton, OR 97801-0160

Phone

(541) 966-9830

Fax

(541) 278-7590

NPI assigned

Sep 21, 2009

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

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 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Yellowhawk Tribal Health Center

  • Clinic/Center
  • Pendleton, OR
  • NPI 1346283488
  NPD (past)
• Assured Imaging Womens Wellness of Washington, LLC

  dba Assured Imaging Women's Wellness

  • Diagnostic Radiology Physician
  • Tukwila, WA
  • NPI 1588982060
  NPD (past)

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

{
    "created_epoch": "1253491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457481600000",
    "number": "1093049306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 160",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978010160",
            "telephone_number": "541-966-9830",
            "fax_number": "541-278-7590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "73265 CONFEDERATED WAY",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978010160",
            "telephone_number": "541-966-9830",
            "fax_number": "541-278-7590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAVER",
        "first_name": "GRADY",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-21",
        "last_updated": "2016-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE60114016",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D9825",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500653068",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wenona R Scott
• Kimberly Seavert
• Misty Seckman
• Richard Seigler
• Cody Nathaniel Sellers, D.O.
• Vivian June Shaw, CRM
• Jeremy Gene Sherrer, QMHA
• Elizabeth Sieders, PA-C
• Simply Healthcare, LLC
• Maria A Simpson

• Dentist in Pendleton, OR
• Providers in Pendleton, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.