Active NPI
Shane Carlos Carrillo, M.D.
- Psychiatry Physician
- Richmond, VA
National Provider Identifier
1114453511
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 0101265348
- Practice address
- 107 S. 5TH St.
Richmond, VA 23219 - Phone
- (804) 828-7912
- NPI assigned
- May 4, 2017
- Last updated
- Feb 27, 2025
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 0101265348 | VA | Primary |
Addresses
Primary practice location
107 S. 5TH St.
Richmond, VA 23219
Mailing address
107 S. 5TH St.
Richmond, VA 23219
Phone (804) 828-7912
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Psychiatry
- Education
- University of Kansas School of Med (KC/Wich/Sal), 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
107 S 5TH St
Richmond, VA 23219-3825
Phone (804) 819-4000
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Richmond Behavioral Health Authority | Current | Accepting new patients |
Locations
107 S 5th St
Richmond, VA 23219
Phone (804) 819-4000
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Richmond, VA
- NPI 1184715328
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1493856000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1740614400000",
"number": "1114453511",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 S. 5TH ST.",
"city": "RICHMOND",
"state": "VA",
"postal_code": "23219",
"telephone_number": "804-828-7912"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "107 S. 5TH ST.",
"city": "RICHMOND",
"state": "VA",
"postal_code": "23219",
"telephone_number": "804-828-7912"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARRILLO",
"first_name": "SHANE",
"middle_name": "CARLOS",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-05-04",
"last_updated": "2025-02-27",
"certification_date": "2025-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "VA",
"license": "0101265348",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richmond, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2025; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.