Active NPI
Paul V Shellabarger, PAC
- Physician Assistant
- Indianola, NE
National Provider Identifier
1265529796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- NE389000
- Practice address
- 119 South 4TH
Indianola, NE 69034 - Phone
- (308) 364-9290
- Fax
- (308) 697-3278
- NPI assigned
- Oct 6, 2006
- Last updated
- Jan 5, 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | NE389000 | NE | Primary |
Addresses
Primary practice location
119 South 4TH
Indianola, NE 69034
Mailing address
PO Box 488
Cambridge, NE 69022-0488
Phone (308) 697-3317
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 389 | Medicaid | NE |
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 389 | NE | MD | Physical Medicine & Rehabilitation Physician |
| NE389000 | NE | MD | Physician Assistant |
Interoperability endpoints
- pauls@yourcarecommunity.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1262649600000",
"number": "1265529796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 488",
"city": "CAMBRIDGE",
"state": "NE",
"postal_code": "690220488",
"telephone_number": "308-697-3317",
"fax_number": "308-697-3278"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "119 SOUTH 4TH",
"city": "INDIANOLA",
"state": "NE",
"postal_code": "69034",
"telephone_number": "308-364-9290",
"fax_number": "308-697-3278"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHELLABARGER",
"first_name": "PAUL",
"middle_name": "V",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-06",
"last_updated": "2010-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NE",
"license": "NE389000",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "389",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianola, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 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.