Individual provider Active NPI

Douglas S Shields, DO

  • Emergency Medicine Physician
  • Medford, OR
National Provider Identifier
1194947390
Registry record updated Sep 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
DO25650 Issued in OR
Practice address
1111 Crater Lake Ave
Medford, OR 97504-6241
Phone
(503) 215-4323
Fax
(503) 215-0297
NPI assigned
May 3, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X DO25650 OR Primary

Addresses

Primary practice location

1111 Crater Lake Ave
Medford, OR 97504-6241

Mailing address

PO Box 3308
Portland, OR 97208-3308
Phone (503) 215-4323

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dshields126791@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20051220000666 OR Practitioner - Emergency Medicine 1658393582 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DO25650ORMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Asante Ashland Community Hospital, LLC CurrentSince May 1, 2018 Accepting new patients

Locations

280 Maple St
Ashland, OR 97520
Phone (541) 201-4000

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600905600000",
    "number": "1194947390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3308",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083308",
            "telephone_number": "503-215-4323",
            "fax_number": "503-215-0297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 CRATER LAKE AVE",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975046241",
            "telephone_number": "503-215-4323",
            "fax_number": "503-215-0297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIELDS",
        "first_name": "DOUGLAS",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-03",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OR",
            "license": "DO25650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dshields126791@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1111 Crater Lake Ave",
            "city": "Medford",
            "state": "OR",
            "country_code": "US",
            "postal_code": "975046241",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.