Individual provider Active NPI

Peter Shi, D.O.

  • Internal Medicine Physician
  • Jackson, TN
National Provider Identifier
1336569904
Registry record updated Oct 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
02005562A Issued in IN
Practice address
620 Skyline Dr
Jackson, TN 38301-3923
Phone
(731) 541-4923
NPI assigned
Apr 22, 2014
Last updated
Oct 15, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 3196 TN
Internal Medicine Physician 207R00000X 02005562A IN Primary

Addresses

Primary practice location

620 Skyline Dr
Jackson, TN 38301-3923

Mailing address

1804 Highway 45 Byp Ste 604
Jackson, TN 38305-4403
Phone (731) 660-8781

Other practice location 1

11109 Parkview Plaza Dr
Fort Wayne, IN 46845-1701
Phone (260) 266-2020

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address pshi483338@Direct.Parkviewexchange.com
FHIR URL https://epicprod-mobile.parkview.com/FHIR/api/FHIR/R4/
FHIR URL https://epicprod-mobile.parkview.com/FHIR/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, IN, AR, VA, DC5 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
I20170825000224 TN Practitioner - HospitalistPractitioner - Internal Medicine 6901178946 Reassigns benefits to 4 organizations
I20181212003108 IN Practitioner - HospitalistPractitioner - Internal Medicine 6901178946 Reassigns benefits to 6 organizations
I20200305000220 AR Practitioner - Internal Medicine 6901178946 Reassigns benefits to 5 organizations
I20200915001221 VA Practitioner - HospitalistPractitioner - Internal Medicine 6901178946 Reassigns benefits to 4 organizations
I20201124000144 DC Practitioner - HospitalistPractitioner - Internal Medicine 6901178946 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
New York College of Osteo Medicine of New York Institute of Technology, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sebastian Physician Services, PLLCGroup PAC ID 5294178448, 41 clinicians
Inova Health Care ServicesGroup PAC ID 2466351093, 1,821 clinicians

Practice addresses (Care Compare)

1001 Towson Ave
Fort Smith, AR 72901-4921
Phone (479) 441-4000

101 Harris Rd
Kilmarnock, VA 22482-3880
Phone (240) 686-2300

3300 Gallows Rd
Falls Church, VA 22042-3307

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3196TNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Hospitalist Physicians, LLP Current Accepting new patients
Apogee Medical Group Indiana PC Internal Medicine CurrentSince Nov 4, 2018 Accepting new patients
Emergency Medicine Associates P.a., P.C. CurrentSince Dec 1, 2021 Accepting new patients
Sound Physicians of Indiana, LLC Internal Medicine CurrentSince Jan 9, 2019 Accepting new patients
CMH Physician Services, LLC Internal Medicine Current Accepting new patients
Maury Regional Medical Group, Inc Internal Medicine CurrentSince Jan 15, 2019 Accepting new patients
Sebastian Physician Services, PLLC CurrentSince Dec 20, 2024 Accepting new patients
Wellmont Medical Associates, Inc. CurrentSince Jan 1, 2019 Accepting new patients
Hospitalist Physicians of Indiana, PC Internal Medicine CurrentSince Apr 1, 2023 Accepting new patients
Northwest Hospitalist Physicians LLP CurrentSince Jun 2, 2021 Accepting new patients
Crawford Physician Services, PLLC CurrentSince Dec 20, 2024 Accepting new patients
Emergency Medicine Associates, P.a.,P.C. Internal Medicine CurrentSince Oct 1, 2021 Accepting new patients
CMH Physician Services, LLC CurrentSince Jun 2, 2022 Accepting new patients
App of Tennessee HM, PLLC CurrentSince May 11, 2021 Accepting new patients
Sound Physicians of Indiana, LLC Internal Medicine CurrentSince Jan 9, 2019 Accepting new patients
Maury Regional Hospital Marshall Medical Center CurrentSince Jan 15, 2019 Accepting new patients
Baptist Health CurrentSince Apr 20, 2020 Accepting new patients
Apogee Medical Group Tennessee PC Internal Medicine CurrentSince Aug 20, 2018 Accepting new patients
Inova Health Care Services CurrentSince Nov 16, 2020 Accepting new patients
Hospitalist Medicine Physicians of Indiana, LLC Internal Medicine CurrentSince Jan 9, 2019 Accepting new patients
Wellmont Medical Associates Inc Internal Medicine CurrentSince Jan 1, 2019 Accepting new patients
Arkansas Post Discharge Services, PLLC CurrentSince Dec 20, 2024 Accepting new patients
Emergency Medicine Associates P.a., P.C. Internal Medicine CurrentSince Oct 1, 2021 Accepting new patients
Southeastern Intensivist Services PC Internal Medicine CurrentSince Jan 1, 2022 Accepting new patients
Baptist Health CurrentSince Apr 20, 2020 Accepting new patients
Arkansas Health Group Internal Medicine CurrentSince Feb 1, 2020 Accepting new patients
Parkview Health System Inc Internal Medicine Current Accepting new patients
Inova Health Care Services Internal Medicine CurrentSince Nov 16, 2020 Accepting new patients
Parkview Health System, Inc. Internal Medicine CurrentSince Apr 9, 2022 Accepting new patients
Arkansas Health Group CurrentSince Feb 1, 2020 Accepting new patients
West Tennessee Medical Group Inc Internal Medicine Past Accepting new patients
Arnot Medical Services PLLC Internal Medicine Past Accepting new patients
Baptist Health Regional Hospitals Past Accepting new patients

Locations (25 of 39)

1001 Towson Ave
Fort Smith, AR 72901
Phone (479) 441-3980

11001 Executive Center Dr
Ste 200
Little Rock, AR 72211
Phone (501) 812-7215

9601 Baptist Health Dr
Little Rock, AR 72205
Phone (501) 202-3995

9601 Interstate 630
Little Rock, AR 72205
Phone (501) 202-2300

9601 Interstate 630
#7
Little Rock, AR 72205
Phone (501) 202-3995

3333 Springhill Dr
North Little Rock, AR 72117
Phone (501) 202-3000

211 Crawford Memorial Dr
Van Buren, AR 72956
Phone (479) 471-4300

15059 N Scottsdale Rd
Ste 600
Scottsdale, AZ 85254
Phone (602) 778-3601

601 W 2nd St
Bloomington, IN 47403
Phone (812) 353-5252

11109 Parkview Plaza Dr
Fort Wayne, IN 46845
Phone (260) 266-2020

2200 Randallia Dr
Fort Wayne, IN 46805
Phone (260) 373-4000

7950 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 434-7088

512 Professional Way
Kendallville, IN 46755
Phone (260) 347-8556

1007 Lincolnway
Laporte, IN 46350
Phone (219) 325-5474

1331 State St
Laporte, IN 46350
Phone (219) 326-2415

5215 Holy Cross Pkwy
Mishawaka, IN 46545
Phone (574) 335-2443

1850 State St
New Albany, IN 47150
Phone (812) 944-7701

1606 N 7th St
Terre Haute, IN 47804
Phone (812) 238-7523

85 E US Highway 6
Valparaiso, IN 46383
Phone (219) 983-5743

520 S 7th St
Vincennes, IN 47591
Phone (812) 885-3280

1224 Trotwood Ave
Columbia, TN 38401
Phone (931) 380-4072

854 W James M Campbell Blvd
Ste 303
Columbia, TN 38401
Phone (931) 388-8779

1 Medical Center Blvd
Cookeville, TN 38501
Phone (931) 783-2334

111 W Stone Dr
Ste 100
Kingsport, TN 37660
Phone (423) 247-5197

130 W Ravine Rd
Kingsport, TN 37660
Phone (423) 224-3150

Interoperability endpoints

  • Direct secure messaging: pshi398655@direct.baptist-healthar.org
  • Direct secure messaging: pshi483338@direct.parkviewexchange.com
  • Direct secure messaging: pshi723417@soc.inova.org

Organizations & group practices 33

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.

View all 33

Hospital & facility affiliations 4

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": "1398124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665792000000",
    "number": "1336569904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1804 HIGHWAY 45 BYP STE 604",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383054403",
            "telephone_number": "731-660-8781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 SKYLINE DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013923",
            "telephone_number": "731-541-4923"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11109 Parkview Plaza Dr",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468451701",
            "country_code": "US",
            "telephone_number": "260-266-2020",
            "fax_number": "260-266-2009",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHI",
        "first_name": "PETER",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-22",
        "last_updated": "2022-10-15",
        "certification_date": "2022-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "3196",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "02005562A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pshi483338@Direct.Parkviewexchange.com",
            "affiliation": "N",
            "address_1": "11109 Parkview Plaza Dr",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451701",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "11109 Parkview Plaza Dr",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451701",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "11109 Parkview Plaza Dr",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jackson, TN

Sources for this page

Verify at the official NPI Registry.