Individual provider Active NPI

Samuel Henderson Shuffler, MD

  • Specialist
  • Lafayette, LA
National Provider Identifier
1104845999
Registry record updated Feb 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
022936 Issued in LA
Practice address
1000 W Pinhook Rd
Suite 304
Lafayette, LA 70503-2460
Phone
(337) 289-9155
Fax
(337) 289-9155
NPI assigned
Jul 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 022936 LA Primary

Addresses

Primary practice location

1000 W Pinhook Rd
Suite 304
Lafayette, LA 70503-2460

Mailing address

120 Rue Louis Xiv
Lafayette, LA 70508-5739
Phone (337) 769-7779

Other identifiers 1

IdentifierTypeStateIssuer
1497967MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050607000014 LA Practitioner - Urology 1355384793 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Texas Medical School at San Antonio, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern Urology LLCGroup PAC ID 5597833772, 27 clinicians

Practice addresses (Care Compare)

120 Rue Louis Xiv
Lafayette, LA 70508-5739
Phone (337) 600-1678

1926 S Union St
Opelousas, LA 70570-5725
Phone (337) 594-4025

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.2 of 100Reported as group
Promoting interoperability
92
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection11
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
022936LAMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Urology, LLC Urology CurrentSince Aug 1, 2008 Accepting new patients
Southern Urology LLC Urology CurrentSince Aug 1, 2008 Accepting new patients

Locations

1000 W Pinhook Rd
Ste 304
Lafayette, LA 70503
Phone (337) 289-9155

120 Rue Louis Xiv
Lafayette, LA 70508
Phone (337) 233-6665

120 Rue Louis Xiv
Bldg 2
Lafayette, LA 70508
Phone (337) 233-6665

913 S College Rd
Ste 209
Lafayette, LA 70503
Phone (337) 233-9546

Interoperability endpoints

  • Direct secure messaging: samuelshuffler@southernuro.medalliesdirect.net

Organizations & group practices 2

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.

Hospital & facility affiliations 5

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": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297036800000",
    "number": "1104845999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 RUE LOUIS XIV",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705085739",
            "telephone_number": "337-769-7779",
            "fax_number": "337-769-7800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 W PINHOOK RD",
            "address_2": "SUITE 304",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705032460",
            "telephone_number": "337-289-9155",
            "fax_number": "337-289-9155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUFFLER",
        "first_name": "SAMUEL",
        "middle_name": "HENDERSON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2011-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "LA",
            "license": "022936",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497967",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, LA

Sources for this page

Verify at the official NPI Registry.