Active NPI
Darell Matthew Shaffer, M.D.
- Psychiatry Physician
- Anoka, MN
National Provider Identifier
1154491900
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 39693
- Practice address
- 3301 7TH Ave
Anoka, MN 55303-4516 - Phone
- (763) 712-4020
- Fax
- (763) 712-4013
- NPI assigned
- Nov 9, 2006
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 39693 | MN | Primary |
Addresses
Primary practice location
3301 7TH Ave
Anoka, MN 55303-4516
Mailing address
3301 7TH Ave
Anoka, MN 55303-4516
Phone (763) 712-4020
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39693 | MN | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anoka Metro Regional Treatment Center | Past | Accepting new patients |
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.
-
- Psychiatric Hospital
- Anoka, MN
- NPI 1275585564
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163030400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154491900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3301 7TH AVE",
"city": "ANOKA",
"state": "MN",
"postal_code": "553034516",
"telephone_number": "763-712-4020",
"fax_number": "763-712-4013"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3301 7TH AVE",
"city": "ANOKA",
"state": "MN",
"postal_code": "553034516",
"telephone_number": "763-712-4020",
"fax_number": "763-712-4013"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAFFER",
"first_name": "DARELL",
"middle_name": "MATTHEW",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MN",
"license": "39693",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anoka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.