NPIMap

Individual provider Active NPI

Jordan Tyler Shively, D.O.

  • Surgery Physician
  • Las Vegas, NV
National Provider Identifier
1194170910
Registry record updated Jul 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
DO2821 Issued in NV
Practice address
8930 W Sunset Rd Ste 300
Las Vegas, NV 89148-5013
Phone
(702) 228-8834
NPI assigned
Apr 29, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X OH
Surgery Physician 208600000X DO2821 NV Primary

Addresses

Primary practice location

8930 W Sunset Rd Ste 300
Las Vegas, NV 89148-5013

Mailing address

8930 W Sunset Rd Ste 300
Las Vegas, NV 89148-5013
Phone (702) 228-8834

Other practice location 1

20000 Harvard Ave
Warrensville Heights, OH 44122-6805
Phone (216) 491-7464

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20210929001997 NV Practitioner - General Surgery 5698067189 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
William Bee Ririe HospitalGroup PAC ID 9335051747, 40 clinicians
LV Surgery Associates PLLCGroup PAC ID 2668840174, 25 clinicians

Practice addresses (Care Compare)

1500 Ave H
Ely, NV 89301-2615
Phone (775) 289-3612

8930 W Sunset Rd
Suite 300
Las Vegas, NV 89148-5013
Phone (702) 258-7788

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy39
Hernia repair (minimally invasive)22
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Varicose vein removal20

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DO2821NVMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
William Bee Ririe Retail Pharmacy CurrentSince Jan 17, 2025 Accepting new patients
LV Surgery Associates PLLC CurrentSince Jan 1, 2023 Accepting new patients
Euclid Hospital Cleveland Clinic Health System Current Accepting new patients
William Bee Ririe Hospital CurrentSince Jan 17, 2025 Accepting new patients
Vegas Vascular Specialists PLLC CurrentSince May 22, 2022 Accepting new patients
Talbert Medical Group Past Accepting new patients
William Bee Ririe Hospital Past Accepting new patients

Locations

6 Steptoe Cir
Ely, NV 89301
Phone (775) 289-3001

1500 Avenue H
Ely, NV 89301
Phone (775) 289-3001

901 N Green Valley Pkwy
Ste 160
Henderson, NV 89074
Phone (702) 258-7788

6850 N Durango Dr
Ste 218
Las Vegas, NV 89149
Phone (702) 202-3431

8930 W Sunset Rd
Ste 300
Las Vegas, NV 89148
Phone (702) 258-7788

1250 S Eastern Ave
Las Vegas, NV 89104
Phone (702) 383-4001

9811 W Charleston Blvd
Ste 2640
Las Vegas, NV 89117

8930 W Sunset Rd
Ste 250
Las Vegas, NV 89148
Phone (702) 258-7788

330 S Lola Ln
Bldg B
Pahrump, NV 89048

Interoperability endpoints

  • Direct secure messaging: jshively379802@direct.ccf.org

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 and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1461888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625097600000",
    "number": "1194170910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8930 W SUNSET RD STE 300",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891485013",
            "telephone_number": "702-228-8834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8930 W SUNSET RD STE 300",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891485013",
            "telephone_number": "702-228-8834"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20000 Harvard Ave",
            "address_purpose": "LOCATION",
            "city": "Warrensville Heights",
            "state": "OH",
            "postal_code": "441226805",
            "country_code": "US",
            "telephone_number": "216-491-7464",
            "fax_number": "216-491-7802",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIVELY",
        "first_name": "JORDAN",
        "middle_name": "TYLER",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-29",
        "last_updated": "2021-07-01",
        "certification_date": "2021-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NV",
            "license": "DO2821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.