Shine John, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

1910 Issued in TX

Practice address

11614 FM 2244 Rd Ste 150
Austin, TX 78738-5471

Phone

(512) 399-5711

Fax

(512) 399-5707

NPI assigned

May 9, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

New York College of Podiatric Medicine, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Privia Medical Group Gulf Coast PLLCGroup PAC ID 4688999022, 511 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shine.john.1@8042.direct.athenahealth.com

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.

• Privia Medical Group Gulf Coast, PLLC

  • Obstetrics & Gynecology Physician
  • Houston, TX
  • NPI 1578969465
  Medicare reassignment Care Compare group NPD
• Privia Medical Group Gulf Coast PLLC

  • Interventional Pain Medicine Physician
  • San Antonio, TX
  • NPI 1457167033
  NPD
• Weil Foot and Ankle Institute LLC

  • Foot & Ankle Surgery Podiatrist
  • Mount Prospect, IL
  • NPI 1710965314
  NPD
• Wayne a. Hurst, DPM, PA

  • Foot & Ankle Surgery Podiatrist
  • Cedar Park, TX
  • NPI 1285717199
  NPD (past)
• Weil Foot and Ankle Institute LLC

  • Podiatrist
  • Chicago, IL
  • NPI 1992678312
  NPD (past)

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

{
    "created_epoch": "1210291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660608000000",
    "number": "1245407295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11614 FM 2244 RD STE 150",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787385471",
            "telephone_number": "512-399-5711",
            "fax_number": "512-399-5707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11614 FM 2244 RD STE 150",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787385471",
            "telephone_number": "512-399-5711",
            "fax_number": "512-399-5707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHN",
        "first_name": "SHINE",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-09",
        "last_updated": "2022-08-16",
        "certification_date": "2021-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "016005365",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "TX",
            "license": "1910",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "TX",
            "license": "1910",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL STATE LICENSE",
            "identifier": "016005365",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF TEXAS",
            "identifier": "1910",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jolly Elizabeth John, PA-C
• Melissa John, RN
• Paul William John
• Robert Evan John, DDS, MHA
• Sarah Elizabeth John, MD
• Steeven John, MD
• Johnny U. Franco, MD, PA
• Bobby Cordell Johns Jr., LCDCI
• Connor Lafleur Johns
• Dylan Johns

• Foot & Ankle Surgery Podiatrist in Austin, TX
• Providers in Austin, TX by specialty
• Foot & Ankle Surgery Podiatrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; 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.