Individual provider Active NPI

Melissa Anne Shaull, MD

  • Family Medicine Physician
  • Arnold, MD
National Provider Identifier
1174676969
Registry record updated Dec 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
D0050360 Issued in MD
Practice address
269 Peninsula Farm Rd Ste F
Arnold, MD 21012-1013
Phone
(410) 518-9808
Fax
(410) 518-9842
NPI assigned
Jan 18, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2021

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 D0050360 MD Primary

Addresses

Primary practice location

269 Peninsula Farm Rd Ste F
Arnold, MD 21012-1013

Mailing address

269 Peninsula Farm Rd Ste F
Arnold, MD 21012-1013
Phone (410) 518-9808

Other names 1

  • Melissa Shaull Lotlikar Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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

Enrollment IDStateProvider typePAC IDDetails
I20070228000262 MD Practitioner - Family Practice 4981706546 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Pennsylvania State University College of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Privia Care Center LLCGroup PAC ID 3274801139, 286 clinicians

Practice addresses (Care Compare)

133 Defense Hwy
Annapolis, MD 21401-7015

269 Peninsula Farm Rd
Suite F
Arnold, MD 21012-1013
Phone (410) 518-9808

301 Saint Paul St
Suite 409
Baltimore, MD 21202-2102
Phone (410) 659-7041

Hospital & facility affiliations

  • Luminis Health Anne Arundel Medical Center, Inc Hospital, Annapolis, MD, CCN 210023

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Care Center LLC Current Accepting new patients
Menocal Medical Services PA Family Medicine Current Accepting new patients
Privia Care Center LLC CurrentSince Jan 1, 2022 Accepting new patients
Privia Medical Group, LLC Family Medicine CurrentSince May 24, 2018 Accepting new patients
Privia Medical Group, LLC CurrentSince May 24, 2018 Accepting new patients
Nova Physician Wellness Center PLLC Family Medicine Past Accepting new patients

Locations

133 Defense Hwy
Ste 112
Annapolis, MD 21401
Phone (410) 573-0140

269 Peninsula Farm Rd
Ste F
Arnold, MD 21012
Phone (410) 279-6567

269 Peninsula Farm Rd
Arnold, MD 21012
Phone (410) 518-9808

301 Saint Paul St
Ste 409
Baltimore, MD 21202
Phone (410) 659-7041

110 Baughmans Ln
Ste 140
Frederick, MD 21702
Phone (240) 215-1138

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4
  • Direct secure messaging: melissa.shaull.1@8042.direct.athenahealth.com

Organizations & group practices 6

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.

Hospital & facility affiliations 2

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": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638662400000",
    "number": "1174676969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "269 PENINSULA FARM RD STE F",
            "city": "ARNOLD",
            "state": "MD",
            "postal_code": "210121013",
            "telephone_number": "410-518-9808",
            "fax_number": "410-518-9842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "269 PENINSULA FARM RD STE F",
            "city": "ARNOLD",
            "state": "MD",
            "postal_code": "210121013",
            "telephone_number": "410-518-9808",
            "fax_number": "410-518-9842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAULL",
        "first_name": "MELISSA",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-18",
        "last_updated": "2021-12-05",
        "certification_date": "2021-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D0050360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "SHAULL LOTLIKAR",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Arnold, MD

Sources for this page

Verify at the official NPI Registry.