Kristin Tyse Shadduck, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

11542 Issued in CA

Practice address

794 Altos Oaks Dr
Los Altos, CA 94024-6013

Phone

(650) 947-9646

Fax

(650) 947-9566

NPI assigned

Aug 1, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Shadduck - Physical Therapy Works IncGroup PAC ID 6507259538, 12 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

98.05 of 100Reported as group

Quality

100

Improvement activities

40

Cost

93.49

Medicare enrollment (NPD)

Enrolled

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.

• Shadduck - Physical Therapy Works Inc

  • Physical Therapist
  • Los Altos, CA
  • NPI 1114678794
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678752000000",
    "number": "1255348462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "794 ALTOS OAKS DR",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940246013",
            "telephone_number": "650-947-9646",
            "fax_number": "650-947-9566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "794 ALTOS OAKS DR",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940246013",
            "telephone_number": "650-947-9646",
            "fax_number": "650-947-9566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHADDUCK",
        "first_name": "KRISTIN",
        "middle_name": "TYSE",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-01",
        "last_updated": "2023-03-14",
        "certification_date": "2023-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "11542",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CG5266",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ555752",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maria Sepetka, MD
• Sejla Serifovic
• Gina Serraiocco, MD
• Ramya Sethuram, MD
• Shadduck - Physical Therapy Works Inc
• Nidhi Malav Shah
• Sagar Vinod Shah, D.D.S.
• Natalie Shahar, LMFT
• Maytal Shalev-Eylath
• Yihsin Megan Shang, R.PH.

• Physical Therapist in Los Altos, CA
• Providers in Los Altos, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.