Ethel Caroline Shore, PA-C

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

0010-07550 Issued in NC

Practice address

3150 Rogers Rd Ste 101
Wake Forest, NC 27587

Phone

(919) 504-4000

Fax

(984) 235-1250

NPI assigned

Jan 3, 2018

Last updated

Feb 28, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: ethel.shore.1@11261.direct.athenahealth.com

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.

• Family First Primary Care PLLC

  • Family Medicine Physician
  • Wake Forest, NC
  • NPI 1336526383
  Medicare reassignment
• NC Elder Care PLLC

  • Internal Medicine Physician
  • High Point, NC
  • NPI 1962948240
  NPD (past)

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

{
    "created_epoch": "1514937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551312000000",
    "number": "1114434990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3150 ROGERS RD STE 101",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275874196",
            "telephone_number": "919-504-4000",
            "fax_number": "984-235-1250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3150 ROGERS RD STE 101",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "27587",
            "telephone_number": "919-504-4000",
            "fax_number": "984-235-1250"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "138 Dublin Square Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Asheboro",
            "state": "NC",
            "postal_code": "272038601",
            "country_code": "US",
            "telephone_number": "336-610-1300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHORE",
        "first_name": "ETHEL",
        "middle_name": "CAROLINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-03",
        "last_updated": "2019-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "0010-07550",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Sherry
• Alison Witkowski Shew, MD
• Nicole Danielle Shifflett, BCBA
• Jennifer Shim, DDS, MSD
• Angelique Shirley, PT
• Benjamen Russell Shrewsberry, BCBA
• Nevin Mahendra Shrimanker, M.D.
• Daniel Thomas Sicking, MD
• Anne Siler
• Jessica Silvani, AU.D.

• Internal Medicine Physician in Wake Forest, NC
• Providers in Wake Forest, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2019; 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.

Verify at the official NPI Registry.