Active NPI
Donovan Shields, PHYSICAL THERAPIST
- General Acute Care Hospital
- Vacaville, CA
National Provider Identifier
1124497110
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Acute Care Hospital
- License
- 38935
- Practice address
- 1 Quality Dr
Vacaville, CA 95688-9494 - Phone
- (707) 624-1833
- NPI assigned
- Sep 19, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | 38935 | CA | Primary |
Addresses
Primary practice location
1 Quality Dr
Vacaville, CA 95688-9494
Mailing address
1131 Yount St
Napa, CA 94559-1802
Phone (707) 259-1541
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq | Health Information Exchange (HIE) | The Permanente Medical Group |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38935 | CA | MD | Registered Respiratory Therapist |
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 and National Provider Directory roles.
-
- Internal Medicine Physician
- Santa Clara, CA
- NPI 1073606299
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644537600000",
"number": "1124497110",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1131 YOUNT ST",
"city": "NAPA",
"state": "CA",
"postal_code": "945591802",
"telephone_number": "707-259-1541"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 QUALITY DR",
"city": "VACAVILLE",
"state": "CA",
"postal_code": "956889494",
"telephone_number": "707-624-1833"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIELDS",
"first_name": "DONOVAN",
"credential": "PHYSICAL THERAPIST",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-09-19",
"last_updated": "2022-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "282N00000X",
"taxonomy_group": "",
"desc": "General Acute Care Hospital",
"state": "CA",
"license": "38935",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
"affiliation": "Y",
"endpointDescription": "Carequality",
"affiliationName": "The Permanente Medical Group",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "C-CDA",
"address_1": "1 Quality Dr",
"city": "Vacaville",
"state": "CA",
"country_code": "US",
"postal_code": "95688",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Vacaville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.