Active NPI
Dennis Clive Shimp, D.O.
- General Practice Physician
- Venice, FL
National Provider Identifier
1205061199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 01663
- Practice address
- 13408 Coluccio St
Venice, FL 34293-4506 - Phone
- (941) 408-8608
- NPI assigned
- May 20, 2009
- Last updated
- May 20, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 01663 | IA | Primary |
Addresses
Primary practice location
13408 Coluccio St
Venice, FL 34293-4506
Mailing address
13408 Coluccio St
Venice, FL 34293-4506
Phone (941) 408-8608
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01663 | IA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1242777600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1242777600000",
"number": "1205061199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13408 COLUCCIO ST",
"city": "VENICE",
"state": "FL",
"postal_code": "342934506",
"telephone_number": "941-408-8608"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13408 COLUCCIO ST",
"city": "VENICE",
"state": "FL",
"postal_code": "342934506",
"telephone_number": "941-408-8608"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIMP",
"first_name": "DENNIS",
"middle_name": "CLIVE",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-05-20",
"last_updated": "2009-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "IA",
"license": "01663",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Venice, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.