Shelley Leilani Davis, P.A.-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

TLP-014 Issued in ID

Practice address

3614 Washington Pkwy
Idaho Falls, ID 83404-7573

Phone

(208) 552-7700

Fax

(208) 552-1786

NPI assigned

Nov 5, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Steele Lake Specialty PLLCGroup PAC ID 1153774567, 20 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Eastern Idaho Regional Medical Center Hospital, Idaho Falls, ID, CCN 130018

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Steele Lake Specialty PLLC

  • Surgery Physician
  • Idaho Falls, ID
  • NPI 1215716998
  Medicare reassignment Care Compare group NPD
• Family First Medical Center, PLLC

  • Family Medicine Physician
  • Idaho Falls, ID
  • NPI 1033314273
  Medicare reassignment
• Idaho Physician Services Inc.

  dba East Falls Orthopedics

  • Orthopaedic Surgery Physician
  • Idaho Falls, ID
  • NPI 1902841893
  NPD (past)
• Frederick Health Hospital Inc

  dba Frederick Health Hospital

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Eastern Idaho Health Services Inc

  dba Eastern Idaho Regional Medical Center

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1225082209
  Care Compare affiliation

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

{
    "created_epoch": "1383609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383609600000",
    "number": "1235568742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3614 WASHINGTON PKWY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047573",
            "telephone_number": "208-552-7700",
            "fax_number": "208-552-1786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3614 WASHINGTON PKWY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047573",
            "telephone_number": "208-552-7700",
            "fax_number": "208-552-1786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "SHELLEY",
        "middle_name": "LEILANI",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-05",
        "last_updated": "2013-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "TLP-014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mercedes Davis
• Michael Davis
• Richard Duke Davis, DMD
• Scott D Davis, DDS
• Shayleigh Davis, PTA
• Timothy Bowen Davis, CRNA
• Tysen Derek Davis
• Hannah Daw
• Ryan Daw
• Allison Dawson, LCSW

• Medical Physician Assistant in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Medical Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.