Active NPI
Nicholas Cody Shaw, ATC
- Athletic Trainer
- Pelahatchie, MS
National Provider Identifier
1336800150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT0567
- Practice address
- 201 South Brooks Avenue
Pelahatchie, MS 39145 - Phone
- (601) 759-5006
- NPI assigned
- Jan 4, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT0567 | MS | Primary |
Addresses
Primary practice location
201 South Brooks Avenue
Pelahatchie, MS 39145
Mailing address
201 South Brooks Avenue
Pelahatchie, MS 39145
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT0567 | MS | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Performance Therapy LLC | Current | Accepting new patients | |
| Performance Therapy LLC | Current | 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 and National Provider Directory roles.
-
- Physical Therapy Clinic/Center
- Carthage, MS
- NPI 1700244878
-
- Physical Therapist
- Philadelphia, MS
- NPI 1851427132
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1641254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641254400000",
"number": "1336800150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 SOUTH BROOKS AVENUE",
"city": "PELAHATCHIE",
"state": "MS",
"postal_code": "39145"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 SOUTH BROOKS AVENUE",
"city": "PELAHATCHIE",
"state": "MS",
"postal_code": "39145",
"telephone_number": "601-759-5006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "NICHOLAS",
"middle_name": "CODY",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-01-04",
"last_updated": "2022-01-04",
"certification_date": "2022-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MS",
"license": "AT0567",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pelahatchie, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.