NPIMap

Individual provider Active NPI

Shane R Son, MD

  • Family Medicine Physician
  • Olympia, WA
National Provider Identifier
1225180698
Registry record updated Oct 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD00041776 Issued in WA
Practice address
404 Black Hills LN SW Ste D
Olympia, WA 98502-8148
Phone
(360) 528-2100
Fax
(360) 528-2104
NPI assigned
Jan 17, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 9, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD00041776 WA Primary

Addresses

Primary practice location

404 Black Hills LN SW Ste D
Olympia, WA 98502-8148

Mailing address

PO Box 12389
Olympia, WA 98508-2389
Phone (360) 528-2100

Other identifiers 2

IdentifierTypeStateIssuer
P00848649OtherWARAILROAD MEDICARE
1025053MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20041105000881 WA Practitioner - Family Practice 6305809856 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

404 Black Hills LN SW
Suite D
Olympia, WA 98502-8148
Phone (360) 528-2100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00041776WAMDFamily Medicine Physician

Interoperability endpoints

  • Direct secure messaging: shane.son.1@16943.direct.athenahealth.com

Organizations & group practices 1

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 10

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": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349740800000",
    "number": "1225180698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12389",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985082389",
            "telephone_number": "360-528-2100",
            "fax_number": "360-528-2104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 BLACK HILLS LN SW STE D",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985028148",
            "telephone_number": "360-528-2100",
            "fax_number": "360-528-2104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SON",
        "first_name": "SHANE",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-17",
        "last_updated": "2012-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00041776",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00848649",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1025053",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

Verify at the official NPI Registry.