Individual provider Active NPI

Mildred Alexandra Shaw, RN

  • Registered Nurse
  • Raleigh, NC
National Provider Identifier
1093340648
Registry record updated Mar 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
247109 Issued in NC
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

Updated by the provider on Mar 4, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

Enrollment IDStateProvider typePAC IDDetails
I20221027003133 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 8729455175 Reassigns benefits to 2 organizations

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 Hospital, Greensboro, NC, CCN 340091

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
6976NCMDGeneral Practice Dentistry
247109NCMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Surgical Center of Greensboro, LLC Current Accepting new patients
The Moses H. Cone Memorial Hospital Operating Corporation CurrentSince Feb 1, 2023 Accepting new patients
Gate City Anesthesia, Inc CurrentSince May 13, 2024 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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

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.

Verify at the official NPI Registry.