Individual provider Active NPI

Shaina Linell McGordon, PA-C

  • Physician Assistant
  • Tifton, GA
National Provider Identifier
1093976508
Registry record updated Jun 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
005098 Issued in GA
Practice address
901 18TH St E
Tifton, GA 31794-3648
Phone
(229) 382-7120
NPI assigned
Jun 18, 2008
Last updated
Jun 24, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 005098 GA Primary

Addresses

Primary practice location

901 18TH St E
Tifton, GA 31794-3648

Mailing address

907 18TH St E
Suite150
Tifton, GA 31794-3643
Phone (229) 382-7120

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20121029000250 GA Practitioner - Physician Assistant 2961652920 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
93.24 of 100Reported as group
Quality
73.72
Promoting interoperability
100
Improvement activities
40
Cost
75.22

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
005098GAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Emory Medical Care Foundation Inc CurrentSince May 1, 2021 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Apr 15, 2023 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Apr 15, 2023 Accepting new patients
Tift Regional Health System Inc CurrentSince Jul 1, 2015 Accepting new patients
Tift Regional Health System Inc. CurrentSince Jul 1, 2015 Accepting new patients
Emory Medical Care Foundation CurrentSince May 1, 2021 Accepting new patients

Locations

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303
Phone (404) 616-4370

3950 Austell Rd
Austell, GA 30106
Phone (770) 732-3752

101 W Ponce de Leon Ave
Decatur, GA 30030
Phone (404) 778-4889

1170 Cleveland Ave
East Point, GA 30344
Phone (404) 305-3500

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

1622 Madison Ave
Tifton, GA 31794
Phone (229) 387-8061

901 18th St E
Tifton, GA 31794
Phone (229) 353-6208

907 18th St E
Ste 150
Tifton, GA 31794
Phone (229) 353-3422

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1213747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435104000000",
    "number": "1093976508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 18TH ST E",
            "address_2": "SUITE150",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943643",
            "telephone_number": "229-382-7120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 18TH ST E",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943648",
            "telephone_number": "229-382-7120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCGORDON",
        "first_name": "SHAINA",
        "middle_name": "LINELL",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-18",
        "last_updated": "2015-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "005098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tifton, GA

Sources for this page

Verify at the official NPI Registry.