NPIMap

Individual provider Active NPI

Timothy Shane Shaw, M.D., P.A.

  • Specialist
  • Livingston, TX
National Provider Identifier
1316930183
Registry record updated Oct 12, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
M1343 Issued in TX
Practice address
601 Ogeltree Dr.
Suite D
Livingston, TX 77351
Phone
(936) 328-8080
Fax
(936) 328-8505
NPI assigned
Aug 26, 2005
Last updated
Oct 12, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X M1343 TX Primary

Addresses

Primary practice location

601 Ogeltree Dr.
Suite D
Livingston, TX 77351

Mailing address

601 Ogletree Dr
Suite D
Livingston, TX 77351-9226
Phone (936) 328-8080

Other identifiers 2

IdentifierTypeStateIssuer
1788538MedicaidLA
P00256091OtherTXMEDICARE RAILROAD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050922001101 TX Practitioner - Orthopedic Surgery 2769416361 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

210 W Park
Suite 100
Livingston, TX 77351-8337
Phone (936) 328-8080

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.15 of 100Reported as individual
Promoting interoperability
99
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement14
Knee replacement36
Upper limb (arm) arthroscopy (minimally invasive joint repair)36

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M1343TXMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
West Park Rehab & Aquatic Center CurrentSince May 1, 2012 Accepting new patients

Organizations & group practices 2

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 5

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

NPI Registry JSON

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

{
    "created_epoch": "1125014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192147200000",
    "number": "1316930183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 OGLETREE DR",
            "address_2": "SUITE D",
            "city": "LIVINGSTON",
            "state": "TX",
            "postal_code": "773519226",
            "telephone_number": "936-328-8080",
            "fax_number": "936-328-8505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 OGELTREE DR.",
            "address_2": "SUITE D",
            "city": "LIVINGSTON",
            "state": "TX",
            "postal_code": "77351",
            "telephone_number": "936-328-8080",
            "fax_number": "936-328-8505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "TIMOTHY",
        "middle_name": "SHANE",
        "credential": "M.D., P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-26",
        "last_updated": "2007-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TX",
            "license": "M1343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1788538",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00256091",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Livingston, TX

Sources for this page

Verify at the official NPI Registry.