NPIMap

Individual provider Active NPI

Anthony F Shedlock, DO

  • Family Medicine Physician
  • Houtzdale, PA
National Provider Identifier
1114038387
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS005348L Issued in PA
Practice address
612 Clara Street
Houtzdale, PA 16651
Phone
(814) 378-9716
Fax
(814) 378-8940
NPI assigned
Aug 31, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS005348L PA Primary

Addresses

Primary practice location

612 Clara Street
Houtzdale, PA 16651

Mailing address

612 Clara Street
Houtzdale, PA 16651
Phone (814) 378-9716

Other identifiers 1

IdentifierTypeStateIssuer
0009830200003MedicaidPA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150828000850 PA Practitioner - General Practice 5496061970 Practice locations: Houtzdale, PA

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Pennsylvania State University College of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

612 Clara St
Houtzdale, PA 16651-1115
Phone (814) 378-9716

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Windber Hospital, Inc. Past Accepting new patients
Pinecroft Medical Center Family Medicine Past Accepting new patients
Tyrone Medical Associates Specs Past Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 65

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

View all 65

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114038387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 CLARA STREET",
            "city": "HOUTZDALE",
            "state": "PA",
            "postal_code": "16651",
            "telephone_number": "814-378-9716",
            "fax_number": "814-378-8940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 CLARA STREET",
            "city": "HOUTZDALE",
            "state": "PA",
            "postal_code": "16651",
            "telephone_number": "814-378-9716",
            "fax_number": "814-378-8940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEDLOCK",
        "first_name": "ANTHONY",
        "middle_name": "F",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS005348L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0009830200003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houtzdale, PA

Sources for this page

Verify at the official NPI Registry.