Active NPI
David E. Shanks
- Internal Medicine Physician
- Charlotte, NC
National Provider Identifier
1114096898
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 20440
- Practice address
- 3717 Latrobe Dr Ste 750
Charlotte, NC 28211-4826 - Phone
- (704) 364-6676
- Fax
- (704) 364-1358
- NPI assigned
- Nov 7, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 20440 | NC | Primary |
Addresses
Primary practice location
3717 Latrobe Dr Ste 750
Charlotte, NC 28211-4826
Mailing address
3717 Latrobe Dr Ste 750
Charlotte, NC 28211-4826
Phone (704) 364-6676
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 75428 | Other | NC | BLUE CROSS |
| 8975428 | Medicaid | NC | |
| 561254125 | Other | NC | CIGNA HEALTHCARE |
| 406291010 | Other | NC | PALMETTO GBA RR MEDICARE |
| 561254125 | Other | NC | UNITED HEALTHCARE |
| 30596 | Other | NC | MEDCOST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20440 | NC | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carolinas Medical Center | Current | Accepting new patients | |
| Carolinas Medical Center | Current | Accepting new patients | |
| Carolinas Medical Center | Current | Accepting new patients |
Locations
2001 Vail Ave
Charlotte, NC 28207
Phone (704) 304-5000
1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251158400000",
"number": "1114096898",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3717 LATROBE DR STE 750",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282114826",
"telephone_number": "704-364-6676",
"fax_number": "704-364-1358"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3717 LATROBE DR STE 750",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282114826",
"telephone_number": "704-364-6676",
"fax_number": "704-364-1358"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANKS",
"first_name": "DAVID",
"middle_name": "E.",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-07",
"last_updated": "2009-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NC",
"license": "20440",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "75428",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8975428",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA HEALTHCARE",
"identifier": "561254125",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTO GBA RR MEDICARE",
"identifier": "406291010",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "561254125",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST",
"identifier": "30596",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.