Active NPI
Mildred Alexandra Shaw, RN
- Registered Nurse
- Raleigh, NC
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 247109
- Practice address
- 4420 Lake Boone TRL
Raleigh, NC 27607-7505 - Phone
- (252) 305-4900
- NPI assigned
- Mar 4, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Registered Nurse | 163W00000X | 247109 | NC | Primary |
Addresses
Primary practice location
4420 Lake Boone TRL
Raleigh, NC 27607-7505
Mailing address
5301 Willow Ridge Dr
Summerfield, NC 27358-7814
Phone (252) 305-4900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1200 N Elm St
Greensboro, NC 27401-1004
Phone (336) 832-7000
1200 N Elm St
Greensboro, NC 27401-1020
501 N Elam Ave
Greensboro, NC 27403-1118
Phone (336) 832-1000
509 E N Elam Ave
FL 3
Greensboro, NC 27403-1118
Phone (336) 832-1970
Hospital & facility affiliations
- Moses H. Cone Memorial Hospital, the
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6976 | NC | MD | General Practice Dentistry |
| 247109 | NC | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Surgical Center of Greensboro, LLC | Current | Accepting new patients | |
| The Moses H. Cone Memorial Hospital Operating Corporation | Current | Accepting new patients | |
| Gate City Anesthesia, Inc | Current | Accepting new patients |
Locations
509 N Elam Ave
Fl 3
Greensboro, NC 27403
Phone (336) 832-1970
705 Green Valley Rd
Greensboro, NC 27408
Phone (336) 272-0012
21A Oak Branch Dr
Greensboro, NC 27407
Phone (336) 478-2664
1200 N Elm St
Greensboro, NC 27401
Phone (336) 574-7000
2400 W Friendly Ave
Greensboro, NC 27403
Phone (336) 832-1100
618 S Main St
Reidsville, NC 27320
Phone (336) 832-7965
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.
-
- Internal Medicine Physician
- Greensboro, NC
- NPI 1013265909
-
- Pain Medicine (Anesthesiology) Physician
- Greensboro, NC
- NPI 1225135361
-
- Ambulatory Surgical Clinic/Center
- Greensboro, NC
- NPI 1245288257
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Greensboro, NC
- NPI 1477591055
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583280000000",
"number": "1093340648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5301 WILLOW RIDGE DR",
"city": "SUMMERFIELD",
"state": "NC",
"postal_code": "273587814",
"telephone_number": "252-305-4900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4420 LAKE BOONE TRL",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276077505",
"telephone_number": "252-305-4900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "MILDRED",
"middle_name": "ALEXANDRA",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-04",
"last_updated": "2020-03-04",
"certification_date": "2020-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NC",
"license": "247109",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.