NPIMap

Individual provider Active NPI

Jason Kimball Shellnut, M.D.

  • Surgery Physician
  • Royal Oak, MI
National Provider Identifier
1144316340
Registry record updated Mar 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
R-6999 Issued in IA
Practice address
1121 Crooks Rd
Royal Oak, MI 48067-1301
Phone
(248) 541-8554
Fax
(248) 541-1791
NPI assigned
Oct 5, 2006
Last updated
Mar 23, 2017By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 23, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X R-6999 IA Primary

Addresses

Primary practice location

1121 Crooks Rd
Royal Oak, MI 48067-1301

Mailing address

1121 Crooks Rd
Royal Oak, MI 48067-1301
Phone (248) 541-8554

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20090812000571 MI Practitioner - Colorectal Surgery (Proctology)Practitioner - General Surgery 8224182183 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Colorectal Surgery (Proctology)Also: General Surgery
Education
University of Iowa, RJ & L Carver College of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1121 Crooks Rd
Royal Oak, MI 48067-1301
Phone (248) 541-7023

28100 Grand River Ave
Farmington Hills, MI 48336-5970

3555 W 13 Mile Rd
Royal Oak, MI 48073-6710

3577 W 13 Mile Rd
Royal Oak, MI 48073-6710

3581 W 13 Mile Rd BCC
Beaumont Breast Care Center
Royal Oak, MI 48073-6710
Phone (248) 551-3300

3601 W 13 Mile Rd
Royal Oak, MI 48073-6712

3601 W 13 Mile Rd Ec
Beaumont Emergency Services Ro
Royal Oak, MI 48073-6712
Phone (248) 898-5058

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy143
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R-6999IAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jason Shellnut, MD, PC Colon & Rectal Surgery CurrentSince Apr 13, 2013 Accepting new patients
William Beaumont Hospital Current Accepting new patients
Oakland Colon & Rectal Assoc P C Colon & Rectal Surgery CurrentSince Aug 1, 2009 Accepting new patients
Beaumont Medical Group- Specialty Services Surgery CurrentSince Jul 14, 2018 Accepting new patients
William Beaumont Hospital Surgery CurrentSince Sep 14, 2010 Accepting new patients
William Beaumont Hospital CurrentSince Sep 14, 2010 Accepting new patients
William Beaumont Hospital Past Accepting new patients

Locations

28100 Grand River Ave
Ste 301
Farmington Hills, MI 48336
Phone (947) 521-1320

1121 Crooks Rd
Royal Oak, MI 48067
Phone (248) 541-7023

3601 W 13 Mile Rd
Royal Oak, MI 48073

26001 Jefferson Ave
Saint Clair Shores, MI 48081
Phone (586) 779-7000

Organizations & group practices 7

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 12

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": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490227200000",
    "number": "1144316340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 CROOKS RD",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480671301",
            "telephone_number": "248-541-8554",
            "fax_number": "248-541-1791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 CROOKS RD",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480671301",
            "telephone_number": "248-541-8554",
            "fax_number": "248-541-1791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHELLNUT",
        "first_name": "JASON",
        "middle_name": "KIMBALL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2017-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IA",
            "license": "R-6999",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Royal Oak, MI

Sources for this page

Verify at the official NPI Registry.