NPIMap

Organization Active NPI

Shelby Medical Associates, PA

  • Adolescent Medicine (Internal Medicine) Physician
  • Shelby, NC
National Provider Identifier
1104819754
Registry record updated Mar 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0000X
Legal business name
SHELBY MEDICAL ASSOCIATES, PA
Practice address
711 N Dekalb St
Shelby, NC 28150-3911
Phone
(704) 482-1482
Fax
(704) 480-6012
NPI assigned
Aug 30, 2005
Last updated
Mar 21, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2011

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

Authorized official

Name
Paul Brent Ferrell, MDNPI 1053304477
Title
President/Physician
Phone
(704) 482-1482

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent Medicine (Internal Medicine) Physician 207RA0000X NU Primary

Addresses

Primary practice location

711 N Dekalb St
Shelby, NC 28150-3911

Mailing address

711 N Dekalb St
Shelby, NC 28150-3911
Phone (704) 482-1482

Other identifiers 1

IdentifierTypeStateIssuer
8902660MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040723001083 NC Part B Supplier - Clinic/Group Practice 2961482435 Receives reassigned benefits from 12 practitioners
Practice locations: Shelby, NC

National Provider Directory

National Provider Directory
Tax ID family
Shelby Medical Associates PA3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300665600000",
    "number": "1104819754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 N DEKALB ST",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281503911",
            "telephone_number": "704-482-1482",
            "fax_number": "704-480-6012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 N DEKALB ST",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281503911",
            "telephone_number": "704-482-1482",
            "fax_number": "704-480-6012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELBY MEDICAL ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-30",
        "last_updated": "2011-03-21",
        "status": "A",
        "authorized_official_last_name": "FERRELL",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "BRENT",
        "authorized_official_title_or_position": "PRESIDENT/PHYSICIAN",
        "authorized_official_telephone_number": "704-482-1482",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RA0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Adolescent Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8902660",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.