Glen David Shapiro, MD

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

M9172 Issued in ID

Practice address

513 N Main St
Hailey, ID 83333

Phone

(877) 754-6330

Fax

(877) 993-1515

NPI assigned

Feb 19, 2007

Last updated

May 23, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Sun Valley Sports Medicine, P.a.

  • Orthopaedic Surgery Physician
  • Ketchum, ID
  • NPI 1124061163
  NPD (past)

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

{
    "created_epoch": "1171843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337731200000",
    "number": "1336283779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 N 2ND AVE",
            "city": "HAILEY",
            "state": "ID",
            "postal_code": "83333",
            "telephone_number": "877-754-6330",
            "fax_number": "877-993-1515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "513 N MAIN ST",
            "city": "HAILEY",
            "state": "ID",
            "postal_code": "83333",
            "telephone_number": "877-754-6330",
            "fax_number": "877-993-1515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAPIRO",
        "first_name": "GLEN",
        "middle_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-19",
        "last_updated": "2012-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "ID",
            "license": "M9172",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0001364855",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCID",
            "identifier": "B6493",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "B6493",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "11289122",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "100000294843",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00247850",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Louis Schenkar, MD
• Jeff Sutton Schetter, HAD
• Derek Anton Schildknecht, DPT
• Amy Schlatter
• Carrie Thomas Scott, LCPC
• Randye Sue Simcoe, RPH
• Smiles 4 Kids Hailey
• Katelyn Smith, PHARMD
• Steven G Snapp, OD
• Luke Snell, PHARMD

• Orthopaedic Surgery Physician in Hailey, ID
• Providers in Hailey, ID by specialty
• Orthopaedic Surgery Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.