Shane Udelhoven, PA-C
Individual provider Active NPI Medical Physician Assistant · Soldotna, AK
NPI 1124355359 · NPPES record last updated Feb 18, 2020
Key facts
- NPI
- 1124355359
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- PADA893 (AK)
- Practice address
- 35670 Kenai Spur Hwy Ste 103a
Soldotna, AK 99669-7649 - Phone
- (907) 260-1655
- Fax
- (980) 495-8870
- NPI assigned
- Nov 9, 2009
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 19
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- River Health and Wellness, LLC
Practice addresses (Care Compare)
35671 Kenai Spur Hwy
Soldotna, AK 99669-7627
Phone (907) 260-1655
Hospital & facility affiliations
- Central Peninsula General Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100525001036 | AK | Practitioner - Physician Assistant | 6608905930 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PADA893 | AK | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peninsula Instacare | Current | Accepting new patients |
Interoperability endpoints
- shane.udelhoven.1@20415.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Medical Physician Assistant | 363AM0700X | PADA893 | AK | Yes |
Addresses
Primary practice location
35670 Kenai Spur Hwy Ste 103a
Soldotna, AK 99669-7649
Mailing address
48690 Tote Rd
Soldotna, AK 99669-9155
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1572984 | Medicaid | AK |
Other providers in Soldotna, AK
- Totalcare Comprehensive Home Health Supply, LTD
- Mary Jean Toutonghi
- Transformation Counseling, LLC
- Joseph Allen Trefren
- Pat Alton Truesdell
- Brian Uhlir
- Upstream Family Medicine Inc
- Urgent Care of Soldotna Inc.
- Val'S Care Coordination LLC
- Carlos A. Valenzuela
All providers in Soldotna, AK · Medical Physician Assistant in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 18, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.