NPIMap

Individual provider Active NPI

Christopher M Shackles, D.O., MPH

  • Vascular & Interventional Radiology Physician
  • Stony Brook, NY
National Provider Identifier
1124448741
Registry record updated Jul 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
306058-01 Issued in NY
Practice address
Stony Brook University Hospital
101 Nichols Road
Stony Brook, NY 11794-0001
Phone
(631) 444-1791
Fax
(631) 444-7689
NPI assigned
Apr 22, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X 306058-01 NY Primary
Surgery Physician 208600000X 946244 NY

Addresses

Primary practice location

Stony Brook University Hospital
101 Nichols Road
Stony Brook, NY 11794-0001

Mailing address

101 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-5400

Other practice location 1

718 Teaneck Rd
Teaneck, NJ 07666-4245
Phone (201) 833-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210524000044 NY Practitioner - Interventional RadiologyPractitioner - Diagnostic Radiology 1153747464 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional RadiologyAlso: Diagnostic Radiology
Education
Touro Un Col of Osteopathic Medicine, New York, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

100 Nicolls Rd
Stony Brook, NY 11794-3407
Phone (631) 638-2121

101 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-5400

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
306058-01NYMDVascular & Interventional Radiology Physician
946244NYMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Stony Brook Radiology, University Faculty Practice Corporation Vascular & Interventional Radiology CurrentSince Jul 5, 2023 Accepting new patients
David W. Lee MD PA PastSince Feb 6, 2007 Accepting new patients
University Hospital at Stony Brook Past Accepting new patients

Locations

101 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-2065

100 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-1560

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.

Hospital & facility affiliations 6

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": "1398124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690243200000",
    "number": "1124448741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 NICOLLS RD",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117940001",
            "telephone_number": "631-444-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "STONY BROOK UNIVERSITY HOSPITAL",
            "address_2": "101 NICHOLS ROAD",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117940001",
            "telephone_number": "631-444-1791",
            "fax_number": "631-444-7689"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "718 Teaneck Rd",
            "address_purpose": "LOCATION",
            "city": "Teaneck",
            "state": "NJ",
            "postal_code": "076664245",
            "country_code": "US",
            "telephone_number": "201-833-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHACKLES",
        "first_name": "CHRISTOPHER",
        "middle_name": "M",
        "credential": "D.O., MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-22",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NY",
            "license": "306058-01",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "946244",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.