NPIMap

Organization Active NPI

Shawn T Engebretsen DMD P a

  • Oral and Maxillofacial Surgery (Dentist)
  • Stuart, FL
National Provider Identifier
1225200173
Registry record updated Apr 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
DN0009427 Issued in FL
Legal business name
SHAWN T ENGEBRETSEN DMD P A
Practice address
841 E Ocean Blvd
Stuart, FL 34994-2427
Phone
(772) 223-0600
NPI assigned
Apr 1, 2008
Last updated
Apr 8, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2010

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

Authorized official

Name
Dr. Shawn T Engebretsen, DMD PANPI 1396789350
Title
Owner
Phone
(772) 223-0600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X DN0009427 FL Primary

Addresses

Primary practice location

841 E Ocean Blvd
Stuart, FL 34994-2427

Mailing address

1825 NW Bright River PT
Stuart, FL 34994-9407
Phone (772) 692-1194

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081121000630 FL Part B Supplier - Clinic/Group Practice 3779651773 Receives reassigned benefits from 1 practitioner
Practice locations: Port Saint Lucie, FL; Stuart, FL

National Provider Directory

National Provider Directory

Locations

1265 SE Port St Lucie Blvd
Port St Lucie, FL 34952
Phone (772) 337-4798

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1207008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270684800000",
    "number": "1225200173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1825 NW BRIGHT RIVER PT",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349949407",
            "telephone_number": "772-692-1194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 E OCEAN BLVD",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349942427",
            "telephone_number": "772-223-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAWN T ENGEBRETSEN DMD P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-01",
        "last_updated": "2010-04-08",
        "status": "A",
        "authorized_official_last_name": "ENGEBRETSEN",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "772-223-0600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD PA"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DN0009427",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stuart, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2010; 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.