Individual provider Active NPI

Shaun M Fox, RD, LDN

  • Registered Dietitian
  • Pittsfield, MA
National Provider Identifier
1215579735
Registry record updated Oct 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
4923-NU-NU Issued in MA
Practice address
510 North St Ste 6
Pittsfield, MA 01201-4117
Phone
(413) 445-9243
NPI assigned
Oct 16, 2019
Last updated
Oct 16, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 4923-NU-NU MA Primary

Addresses

Primary practice location

510 North St Ste 6
Pittsfield, MA 01201-4117

Mailing address

510 North St Ste 6
Pittsfield, MA 01201-4117
Phone (413) 445-9243

Other identifiers 1

IdentifierTypeStateIssuer
4923-NU-NUOtherMAMASSACHUSETTS DEPARTMENT OF PUBLIC LICENSURE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200203000608 MA Practitioner - Registered Dietitian Or Nutrition Professional 8628404183 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4923MAMDClinical Neuropsychologist
4923-NU-NUMAMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Berkshire Medical Center, Inc CurrentSince Dec 4, 2019 Accepting new patients
North Adams Regional Hospital Corporation CurrentSince May 6, 2024 Accepting new patients
North Adams Regional Hospital Corporation CurrentSince May 6, 2024 Accepting new patients
Berkshire Medical Center Inc. CurrentSince Dec 4, 2019 Accepting new patients

Locations

71 Hospital Ave
North Adams, MA 01247
Phone (413) 664-4343

725 North St
Pittsfield, MA 01201
Phone (413) 447-2839

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1571184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571184000000",
    "number": "1215579735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 NORTH ST STE 6",
            "city": "PITTSFIELD",
            "state": "MA",
            "postal_code": "012014117",
            "telephone_number": "413-445-9243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 NORTH ST STE 6",
            "city": "PITTSFIELD",
            "state": "MA",
            "postal_code": "012014117",
            "telephone_number": "413-445-9243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOX",
        "first_name": "SHAUN",
        "middle_name": "M",
        "credential": "RD, LDN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-16",
        "last_updated": "2019-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MA",
            "license": "4923-NU-NU",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MASSACHUSETTS DEPARTMENT OF PUBLIC LICENSURE",
            "identifier": "4923-NU-NU",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pittsfield, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.