Individual provider Active NPI

Christina Roland Shaw, MSW, LCSW

  • Clinical Social Worker
  • Jamestown, NC
National Provider Identifier
1295018521
Registry record updated Apr 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C007382 Issued in NC
Practice address
960 Chatfield Dr
Jamestown, NC 27282-9028
Phone
(336) 309-3947
NPI assigned
Sep 22, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X C007382 NC Primary

Addresses

Primary practice location

960 Chatfield Dr
Jamestown, NC 27282-9028

Mailing address

960 Chatfield Dr
Jamestown, NC 27282-9028
Phone (336) 309-3947

Other practice location 1

175 Kimel Park Dr Ste 100
Winston Salem, NC 27103-6951
Phone (336) 718-3550

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210528000030 NC Practitioner - Clinical Social Worker 2163821992 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Forsyth Memorial Hospital IncGroup PAC ID 9537071790, 622 clinicians

Practice addresses (Care Compare)

175 Kimel Park Dr
Suite 100
Winston Salem, NC 27103-6951
Phone (336) 718-3550

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince Mar 25, 2021 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Forsyth Memorial Hospital Inc CurrentSince Mar 25, 2021 Accepting new patients
Forsyth Memorial Hospital, Inc. CurrentSince Mar 25, 2021 Accepting new patients
Novant Health Medical Group, LLC Clinical CurrentSince Mar 25, 2021 Accepting new patients
Forsyth Memorial Hospital, Inc. Current Accepting new patients

Locations

200 Hawthorne Ln
Charlotte, NC 28204
Phone (704) 377-2424

3545 Whitehall Park Dr
Ste 300
Charlotte, NC 28273
Phone (704) 316-6187

1900 Randolph Rd
Ste 800
Charlotte, NC 28207
Phone (704) 941-4171

6301 Stadium Dr
Clemmons, NC 27012
Phone (336) 766-6473

13815 Professional Center Dr
Ste 100
Huntersville, NC 28078
Phone (704) 316-2050

291 Broad St
Kernersville, NC 27284
Phone (336) 993-8181

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

175 Kimel Park Dr
Ste 100
Winston Salem, NC 27103
Phone (336) 277-1811

Organizations & group practices 6

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": "1316649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618963200000",
    "number": "1295018521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 CHATFIELD DR",
            "city": "JAMESTOWN",
            "state": "NC",
            "postal_code": "272829028",
            "telephone_number": "336-309-3947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 CHATFIELD DR",
            "city": "JAMESTOWN",
            "state": "NC",
            "postal_code": "272829028",
            "telephone_number": "336-309-3947"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "175 Kimel Park Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271036951",
            "country_code": "US",
            "telephone_number": "336-718-3550",
            "fax_number": "336-277-1825",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAW",
        "first_name": "CHRISTINA",
        "middle_name": "ROLAND",
        "name_prefix": "Mrs.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-22",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C007382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamestown, NC

Sources for this page

Verify at the official NPI Registry.