Active NPI
Chadwick J Shade, PHD
- Clinical Psychologist
- Elmendorf AFB, AK
National Provider Identifier
1255658860
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY0091
- Practice address
- 5955 Zeamer Avenue
3Rd MDG
Elmendorf AFB, AK 99506 - Phone
- (907) 580-2181
- NPI assigned
- Apr 23, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY0091 | MO | Primary |
Addresses
Primary practice location
5955 Zeamer Avenue
3Rd MDG
Elmendorf AFB, AK 99506
Mailing address
5955 Zeamer Avenue
3Rd MDG
Elmendorf AFB, AK 99506
Phone (907) 580-2181
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY0091 | MO | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1271980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1271980800000",
"number": "1255658860",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5955 ZEAMER AVENUE",
"address_2": "3RD MDG",
"city": "ELMENDORF AFB",
"state": "AK",
"postal_code": "99506",
"telephone_number": "907-580-2181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5955 ZEAMER AVENUE",
"address_2": "3RD MDG",
"city": "ELMENDORF AFB",
"state": "AK",
"postal_code": "99506",
"telephone_number": "907-580-2181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHADE",
"first_name": "CHADWICK",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-04-23",
"last_updated": "2010-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MO",
"license": "PSY0091",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elmendorf AFB, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.