NPIMap

Individual provider Active NPI

Chelsea Marie Shine, DO

  • Family Medicine Physician
  • Wichita Falls, TX
National Provider Identifier
1124607080
Registry record updated Oct 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
V0165 Issued in TX
Practice address
501 Midwestern Pkwy E
Wichita Falls, TX 76302-2302
Phone
(940) 716-5750
Fax
(940) 716-5772
NPI assigned
Apr 6, 2021
Last updated
Oct 2, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X V0165 TX Primary

Addresses

Primary practice location

501 Midwestern Pkwy E
Wichita Falls, TX 76302-2302

Mailing address

501 Midwestern Pkwy E
Wichita Falls, TX 76302-2302
Phone (940) 716-5750

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20240720000515 TX Practitioner - Family Practice 8527476332 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Kansas City University of Med & Biosciences, College of Osteo Med, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Clinics of North Texas LLPGroup PAC ID 8820993496, 33 clinicians

Practice addresses (Care Compare)

501 Midwestern Pkwy E
Clin of N TX LLP Rad
Wichita Falls, TX 76302-2302
Phone (940) 766-3551

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.34 of 100Reported as group
Quality
72.51
Promoting interoperability
100
Improvement activities
40
Cost
65.28

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Clinics of North Texas LLP Current Accepting new patients
Clinics of North Texas LLP Family Medicine CurrentSince Sep 2, 2024 Accepting new patients

Locations

501 Midwestern Pkwy E
Wichita Falls, TX 76302
Phone (940) 766-3551

Interoperability endpoints

  • Direct secure messaging: chelseashine@cntllp.allscriptsdirect.net

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 7

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": "1617667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727827200000",
    "number": "1124607080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 MIDWESTERN PKWY E",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763022302",
            "telephone_number": "940-716-5750",
            "fax_number": "940-716-5772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 MIDWESTERN PKWY E",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763022302",
            "telephone_number": "940-716-5750",
            "fax_number": "940-716-5772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHINE",
        "first_name": "CHELSEA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-06",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "V0165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita Falls, TX

Sources for this page

Verify at the official NPI Registry.