Richard A. Shockley, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901011400 Issued in MI

Practice address

706 W Centre Ave
Portage, MI 49024-5310

Phone

(269) 323-1679

Fax

(269) 323-1536

NPI assigned

May 10, 2006

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 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Midwest Family Dental Care Portage PC

  • General Practice Dentistry
  • Portage, MI
  • NPI 1902782592
  NPD (past)

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332460800000",
    "number": "1194775502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "706 W CENTRE AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490245310",
            "telephone_number": "269-323-1679",
            "fax_number": "269-323-1536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706 W CENTRE AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490245310",
            "telephone_number": "269-323-1679",
            "fax_number": "269-323-1536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOCKLEY",
        "first_name": "RICHARD",
        "middle_name": "A.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-10",
        "last_updated": "2012-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901011400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2908240",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Debra Shattuck
• Ann Patrice Sheehan, DNP, CPNP
• Amy Sherman
• Emily Walker Sherwood, M.A.
• Shea-Lin Shobowale-Benson, PHD, LLC
• Shrieeji Inc
• Patricia Shull-Blood, LLP
• Kimberly Sieklucki
• Haley Rose Sikkenga, PT, DPT
• Karolina Silinyte

• General Practice Dentistry in Portage, MI
• Providers in Portage, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.