Shad Misseldine, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

43059 Issued in AZ

Practice address

7600 N 15TH St Ste 290
Phoenix, AZ 85020-4336

Phone

(602) 312-0855

NPI assigned

Aug 14, 2007

Sex

Male

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 1

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Anesthesiology

Education

Ohio State University College of Medicine, 2005

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Shad Misseldine, Inc.

  • Anesthesiology Physician
  • Phoenix, AZ
  • NPI 1164868345
  Medicare reassignment Authorized official
• Camelback Anesthesia PLLC

  • Pain Medicine (Anesthesiology) Physician
  • Tempe, AZ
  • NPI 1831560176
  Medicare reassignment NPD

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

{
    "created_epoch": "1187049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682035200000",
    "number": "1255523213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7600 N 15TH ST STE 290",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850204336",
            "telephone_number": "602-312-0855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7600 N 15TH ST STE 290",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850204336",
            "telephone_number": "602-312-0855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISSELDINE",
        "first_name": "SHAD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-14",
        "last_updated": "2023-04-21",
        "certification_date": "2023-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AZ",
            "license": "43059",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "539882",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lopa M Misra, D.O.
• Suman Misra
• Miss Ghost LLC
• Nizamid-Din B Missaghi, MD
• Misscpv Holdings, LLC
• Mission Care Family Services LLC
• Mission Grace Home Care, LLC
• Mission Kidz Group
• Missionary Home Health and Staffing Inc
• Lynne Margaret Misztal, LCSW

• Anesthesiology Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Anesthesiology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2023; 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.