NPIMap

Individual provider Active NPI

Garrett Shackleton, M.D.

  • Colon & Rectal Surgery Physician
  • Waukee, IA
National Provider Identifier
1295183184
Registry record updated Feb 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
License
MD-56398 Issued in IA
Practice address
2515 Grand Prairie Pkwy
Waukee, IA 50263-8979
Phone
(515) 265-1300
NPI assigned
Jun 1, 2016
Last updated
Feb 3, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MD-56398 IA
Colon & Rectal Surgery Physician 208C00000X MD-56398 IA Primary

Addresses

Primary practice location

2515 Grand Prairie Pkwy
Waukee, IA 50263-8979

Mailing address

2515 Grand Prairie Pkwy
Waukee, IA 50263-8979

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, IA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220908003380 CO Practitioner - General Surgery 6608160411 Reassigns benefits to 1 organization
I20260227003095 IA Practitioner - Colorectal Surgery (Proctology) 6608160411 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

1400 E Boulder St
Suite 500 Ear Nose and Throat Clinic Mem Hosp
Colorado Springs, CO 80909-5533
Phone (719) 364-4120

2515 Grand Prairie Pkwy
Waukee, IA 50263-8966
Phone (515) 644-9000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD-56398IAMDColon & Rectal Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC Surgery CurrentSince Sep 25, 2022 Accepting new patients
Iowa Physicians Clinic Medical Foundation Surgery CurrentSince Mar 16, 2026 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Sep 25, 2022 Accepting new patients
Uch-MHS Past Accepting new patients

Locations

1400 E Boulder St
Ste 500
Colorado Springs, CO 80909
Phone (719) 364-6487

1400 E Boulder St
Ste 500EAR
Colorado Springs, CO 80909
Phone (719) 364-4120

4110 Briargate Pkwy
Ste 460
Colorado Springs, CO 80920
Phone (719) 364-6487

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

4480 Utica Ridge Rd
Ste 2230
Bettendorf, IA 52722
Phone (563) 742-5150

1301 Pennsylvania Ave
Ste 411
Des Moines, IA 50316
Phone (515) 263-2611

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.

Hospital & facility affiliations 21

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1464739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770076800000",
    "number": "1295183184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2515 GRAND PRAIRIE PKWY",
            "city": "WAUKEE",
            "state": "IA",
            "postal_code": "502638979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2515 GRAND PRAIRIE PKWY",
            "city": "WAUKEE",
            "state": "IA",
            "postal_code": "502638979",
            "telephone_number": "515-265-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKLETON",
        "first_name": "GARRETT",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-01",
        "last_updated": "2026-02-03",
        "certification_date": "2026-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IA",
            "license": "MD-56398",
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "IA",
            "license": "MD-56398",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukee, IA

Sources for this page

Verify at the official NPI Registry.