Individual provider Active NPI

Shawn Aaron McGowan, PA

  • Physician Assistant
  • Ellsworth, KS
National Provider Identifier
1114927654
Registry record updated Jul 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
15-00844 Issued in KS
Practice address
1602 N Aylward Ave
Ellsworth, KS 67439-2541
Phone
(785) 472-3111
Fax
(785) 472-5396
NPI assigned
Jul 27, 2005
Last updated
Jul 18, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 15-00844 KS Primary

Addresses

Primary practice location

1602 N Aylward Ave
Ellsworth, KS 67439-2541

Mailing address

1602 N Aylward Ave
Ellsworth, KS 67439-2541
Phone (785) 472-3111

Other identifiers 3

IdentifierTypeStateIssuer
042776OtherKSBCBS
100403740AMedicaidKS
414650OtherKSFIRST GUARD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
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

Enrollment IDStateProvider typePAC IDDetails
I20050505000663 KS Practitioner - Physician Assistant 1153361423 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ellsworth County Medical CenterGroup PAC ID 5395643357, shared by 6 NPIs, 13 clinicians

Practice addresses (Care Compare)

1602 Aylward Ave
Ellsworth, KS 67439-2541
Phone (785) 810-1177

1604 Aylward Ave
Ellsworth, KS 67439-2541
Phone (785) 472-3111

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
15-00844KSMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ellsworth County Medical Center CurrentSince Oct 1, 2001 Accepting new patients
Ellsworth County Medical Center CurrentSince Oct 1, 2001 Accepting new patients

Locations

1602 Aylward Ave
Ellsworth, KS 67439
Phone (785) 472-3111

1604 Aylward Ave
Ellsworth, KS 67439
Phone (785) 472-3111

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": "1122422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374105600000",
    "number": "1114927654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1602 N AYLWARD AVE",
            "city": "ELLSWORTH",
            "state": "KS",
            "postal_code": "674392541",
            "telephone_number": "785-472-3111",
            "fax_number": "785-472-5396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1602 N AYLWARD AVE",
            "city": "ELLSWORTH",
            "state": "KS",
            "postal_code": "674392541",
            "telephone_number": "785-472-3111",
            "fax_number": "785-472-5396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCGOWAN",
        "first_name": "SHAWN",
        "middle_name": "AARON",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-27",
        "last_updated": "2013-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "15-00844",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "042776",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100403740A",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST GUARD",
            "identifier": "414650",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellsworth, KS

Sources for this page

Verify at the official NPI Registry.