Samuel Mark Shor, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

101036333 Issued in VA

Practice address

1860 Town Center Dr
Suite 230
Reston, VA 20190-5896

Phone

(703) 709-1119

Fax

(703) 709-7496

NPI assigned

Oct 5, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Aug 7, 2017 through Aug 7, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)
• Ozarks Medical Center

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  NPD (past)

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

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325721600000",
    "number": "1184611964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1860 TOWN CENTER DR",
            "address_2": "SUITE 230",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201905896",
            "telephone_number": "703-709-1119",
            "fax_number": "703-709-7496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1860 TOWN CENTER DR",
            "address_2": "SUITE 230",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201905896",
            "telephone_number": "703-709-1119",
            "fax_number": "703-709-7496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOR",
        "first_name": "SAMUEL",
        "middle_name": "MARK",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-05",
        "last_updated": "2012-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "101036333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPPO PROVIDER NUMBER",
            "identifier": "504468",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA PROVIDER NUMBER",
            "identifier": "745990",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katie Shen, DNP, NP
• Nancy Ruth Sherwood, BA, IBCLC
• Devin Moore Shiple
• Mohammad Farhaj Shirazi, M.D.
• Robert A. Shor, M.D.
• Meredith Showacre, LPC
• Deepa Laxmi Shrestha, OTR L
• Ellen Shriver, PT, DPT
• Moshe Shtuhl, PH.D.
• Padma Kant Shukla, MD FACP FACC

• Internal Medicine Physician in Reston, VA
• Providers in Reston, VA by specialty
• Internal Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2012; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.