Jack M. Shields,M.D., PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MA35038 Issued in NJ

Legal business name

JACK M. SHIELDS,M.D., PA

Practice address

20 Magnolia Ave
Building B , Suite C
Bridgeton, NJ 08302-1759

Phone

(856) 455-8833

NPI assigned

Sep 12, 2007

Last updated

Sep 13, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jack M. Shields, M.D.NPI 1730119934

Title

Ceo/President

Phone

(856) 455-8833

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

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.

• Jack M Shields, M.D.

  • Internal Medicine Physician
  • Bridgeton, NJ
  • NPI 1730119934
  Medicare reassignment Care Compare group NPD Authorized official
• Lorraine Michelle Santucci, PHD RN APNC

  • Nurse Practitioner
  • Millville, NJ
  • NPI 1538154349
  Medicare reassignment Care Compare group NPD
• Diane M Burt, RN, MSN, APN-C

  • Psychiatric/Mental Health Nurse Practitioner
  • Bridgeton, NJ
  • NPI 1043229883
  NPD (past)
• David Seth Shields, MD

  • Gastroenterology Physician
  • Vineland, NJ
  • NPI 1205828365
  NPD (past)

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

{
    "created_epoch": "1189555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189641600000",
    "number": "1245425206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 MAGNOLIA AVE",
            "address_2": "BUILDING B , SUITE C",
            "city": "BRIDGETON",
            "state": "NJ",
            "postal_code": "083021759",
            "telephone_number": "856-455-8833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 MAGNOLIA AVE",
            "address_2": "BUILDING B , SUITE C",
            "city": "BRIDGETON",
            "state": "NJ",
            "postal_code": "083021759",
            "telephone_number": "856-455-8833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK M. SHIELDS,M.D., PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-12",
        "last_updated": "2007-09-13",
        "status": "A",
        "authorized_official_last_name": "SHIELDS",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "856-455-8833",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "MA35038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3019501",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Inspira Medical Centers, Inc. (Inspira Inpatient Adult Behavioral Health Bridgeton)
• Internal Medicine Associates, PA
• Iqbal and Khan Surgical Associates PA
• Nauveed Iqbal, MD
• Elham M Ismail, MD
• Tiana Lee Jackson
• Christine Jaeger
• James Chiropractic Center
• Ronald James, DC
• Cheryl-Lynn Jean-Pierre

• Internal Medicine Physician in Bridgeton, NJ
• Providers in Bridgeton, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2007; 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.