Active NPI
Gray Shaneberger, PA-C
- Physician Assistant
- Anchorage, AK
National Provider Identifier
1346576857
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1015
- Practice address
- 4315 Diplomacy Dr
Anchorage, AK 99508-5926 - Phone
- (907) 729-1729
- NPI assigned
- Oct 19, 2009
- Last updated
- Jan 12, 2015
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1015 | AK | Primary |
Addresses
Primary practice location
4315 Diplomacy Dr
Anchorage, AK 99508-5926
Mailing address
4315 Diplomacy Dr
Anchorage, AK 99508-5926
Phone (907) 729-1729
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)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Atlantic Professional Services of New Jersey, P.a. | Physician Assistant | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Physician Assistant
- Stratford, NJ
- NPI 1932145182
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421020800000",
"number": "1346576857",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4315 DIPLOMACY DR",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995085926",
"telephone_number": "907-729-1729"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4315 DIPLOMACY DR",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995085926",
"telephone_number": "907-729-1729"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANEBERGER",
"first_name": "GRAY",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-10-19",
"last_updated": "2015-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AK",
"license": "1015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anchorage, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.