NPIMap

Individual provider Active NPI

Jason T Shuffitt, DNP, APRN, FNP-BC

  • Family Nurse Practitioner
  • Bowling Green, KY
National Provider Identifier
1265692438
Registry record updated Sep 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
3005814 Issued in KY
Practice address
1212 Ashley Cir
Suite 5
Bowling Green, KY 42104-5821
Phone
(270) 228-0992
Fax
(270) 854-1835
NPI assigned
Jun 11, 2008
Last updated
Sep 1, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 3005814 KY Primary

Addresses

Primary practice location

1212 Ashley Cir
Suite 5
Bowling Green, KY 42104-5821

Mailing address

1212 Ashley Cir
Suite 5
Bowling Green, KY 42104-5821
Phone (270) 228-0992

Other identifiers 1

IdentifierTypeStateIssuer
7100037790MedicaidKY

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

State licenses

LicenseStateTypeSpecialty
3005814KYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Family Care Clinical Services, PLLC Family Current Accepting new patients
NP Primary Care Clinical Services Current Accepting new patients
Commonwealth Health Corporation, Inc. Past Accepting new patients
Commonwealth Health Corp, Inc. Family Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1213142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472688000000",
    "number": "1265692438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1212 ASHLEY CIR",
            "address_2": "SUITE 5",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421045821",
            "telephone_number": "270-228-0992",
            "fax_number": "270-854-1835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 ASHLEY CIR",
            "address_2": "SUITE 5",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421045821",
            "telephone_number": "270-228-0992",
            "fax_number": "270-854-1835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUFFITT",
        "first_name": "JASON",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DNP, APRN, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-11",
        "last_updated": "2016-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3005814",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100037790",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.