Individual provider Active NPI

Lytitia Marie Fadell Shea, MD

  • Pediatrics Physician
  • Rochester, MN
National Provider Identifier
1265400691
Registry record updated Jun 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
69424 Issued in MN
Practice address
200 1St St SW
Rochester, MN 55905-1601
Phone
(507) 284-2511
NPI assigned
Mar 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X G161873 CA
Pediatrics Physician 208000000X 01050721 IN
Pediatrics Physician 208000000X 69424 MN Primary

Addresses

Primary practice location

200 1St St SW
Rochester, MN 55905-1601

Mailing address

200 1St St SW
Rochester, MN 55905-0001
Phone (507) 284-2511

Other names 1

  • Lytitia M Shea Professional name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lshea1421615@ehrdirect.mayoclinicmsg.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, MN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20200406002307 CA Practitioner - Pediatric Medicine 5991809188 Reassigns benefits to 1 organization
I20210622001006 MN Practitioner - Pediatric Medicine 5991809188 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G161873CAMDPediatrics Physician
01050721INMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Current Accepting new patients
Mayo Clinic CurrentSince Jun 21, 2021 Accepting new patients
Mayo Clinic CurrentSince Jun 21, 2021 Accepting new patients
LPCH Medical Group Div of Lucile Pediatrics CurrentSince Mar 1, 2020 Accepting new patients
Mayo Clinic Past Accepting new patients

Locations

725 Welch Rd
Palo Alto, CA 94304
Phone (650) 497-8979

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

Interoperability endpoints

  • Direct secure messaging: lshea1421615@ehrdirect.mayoclinicmsg.org

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1141948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623628800000",
    "number": "1265400691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 1ST ST SW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559050001",
            "telephone_number": "507-284-2511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 1ST ST SW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559051601",
            "telephone_number": "507-284-2511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEA",
        "first_name": "LYTITIA",
        "middle_name": "MARIE FADELL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-10",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G161873",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01050721",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "69424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lshea1421615@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "200 1st St SW",
            "city": "Rochester",
            "state": "MN",
            "country_code": "US",
            "postal_code": "559051601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LYTITIA",
            "last_name": "SHEA",
            "middle_name": "M",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Rochester, MN

Sources for this page

Verify at the official NPI Registry.