Brian Shackleford, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

2019-00729 Issued in NC

Practice address

Medical Center Blvd
Winston Salem, NC 27157-0001

Phone

(336) 716-2011

NPI assigned

May 13, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

HospitalistAlso: Internal Medicine

Education

Other, 2016

Medicare assignment

May accept Medicare assignment

Group practices

George R Kilpatrick Jr MD PAGroup PAC ID 3779610001, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kindred Hospital Greensboro Long-term care hospital, Greensboro, NC, CCN 342012
• Select Specialty Hospital Durham Inc Long-term care hospital, Durham, NC, CCN 342018
• Kindred Hospital East Greensboro Nursing home, Greensboro, NC, CCN 345273

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: brian.shackleford.1@25637.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/25637/brand/1/csg/1/fhir/r4

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.

• Genesis Medical Practice, PLLC

  • Internal Medicine Physician
  • Greensboro, NC
  • NPI 1205662004
  Medicare reassignment NPD Authorized official
• George R Kilpatrick Jr MD PA

  • Internal Medicine Physician
  • Greensboro, NC
  • NPI 1942412713
  Medicare reassignment Care Compare group NPD
• Legacy Medical Group, PLLC

  • Internal Medicine Physician
  • Greensboro, NC
  • NPI 1558010843
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Kindred Hospitals East, LLC

  • Skilled Nursing Facility
  • Greensboro, NC
  • NPI 1134298615

  Nursing home

  Care Compare affiliation
• Kindred Hospitals East, LLC

  • Long Term Care Hospital
  • Greensboro, NC
  • NPI 1881772713

  Long-term care hospital

  Care Compare affiliation
• Select Specialty Hospital - Durham Inc

  • Long Term Care Hospital
  • Durham, NC
  • NPI 1306845482

  Long-term care hospital

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566777600000",
    "number": "1154777662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "27103",
            "telephone_number": "336-716-2011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-716-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKLEFORD",
        "first_name": "BRIAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-13",
        "last_updated": "2019-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2019-00729",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Seymore, M.D.
• Ahmad Hisham Mohammad Shaban, MD
• Shakirah Jowharah Shabazz, MS,CRC,LPC
• Sarah Shabih, MD
• Judy Denise Shackett
• Victoria Rose Shada, MD
• Millicent Johnson Shadden, LCSW
• Shaffer Counseling
• Thomas Shaffer, LCMHC-S
• Anna Shaffner, LPCA

• Internal Medicine Physician in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.