Ian Shaver

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

27278 Issued in SC

Practice address

939 Springdale Dr
Clinton, SC 29325-7266

Phone

(910) 742-9243

Fax

(888) 746-1787

NPI assigned

Mar 9, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Lifesource of North Carolina 172 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Lifesource of North Carolina

  • General Practice Physician
  • Clinton, SC
  • NPI 1972861789

  SC

  Medicare reassignment Care Compare group NPD
• Lifesource Prime Inc

  • Family Medicine Physician
  • Clinton, SC
  • NPI 1851143523

  SC

  Medicare reassignment NPD
• Lifesource of North Carolina

  • Psychologist
  • Milton, FL
  • NPI 1730648288

  Psychiatric/Mental Health

  Care Compare group NPD
• Lifesource of North Carolina

  • Clinical Social Worker
  • Richmond, VA
  • NPI 1114419124
  Care Compare group
• Lifesource of North Carolina

  • Clinical Social Worker
  • Pikeville, KY
  • NPI 1538728183
  Care Compare group
• Lifesource of North Carolina

  • Clinical Social Worker
  • Holland, OH
  • NPI 1619515277
  Care Compare group
• Lifesource of North Carolina

  • Internal Medicine Physician
  • Wilmington, NC
  • NPI 1811286156
  Care Compare group
• Lifesource of North Carolina

  • General Practice Physician
  • Irondale, AL
  • NPI 1821535428
  Care Compare group
• Lifesource of North Carolina

  • Clinical Social Worker
  • Milwaukee, WI
  • NPI 1871135723
  Care Compare group
• Lifesource of North Carolina

  • General Practice Physician
  • Rome, GA
  • NPI 1962940817
  Care Compare group
• Lifesource Prime Inc

  • Family Medicine Physician
  • Richmond, VA
  • NPI 1548124159
  NPD

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

{
    "created_epoch": "1678320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684713600000",
    "number": "1356041065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1086 SECESSIONVILLE RD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294129744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "939 SPRINGDALE DR",
            "city": "CLINTON",
            "state": "SC",
            "postal_code": "293257266",
            "telephone_number": "910-742-9243",
            "fax_number": "888-746-1787"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1086 Secessionville Rd",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294129744",
            "country_code": "US",
            "telephone_number": "704-681-2417",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAVER",
        "first_name": "IAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-03-09",
        "last_updated": "2023-05-22",
        "certification_date": "2023-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "321428",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "SC",
            "license": "27278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Self Regional Healthcare
• Self Regional Healthcare
• Self Regional Healthcare
• Pennye Semino
• Senior Options, Inc.
• Kayce Shealy, PHARM.D.
• Elyse Alexandra Shearer, MS, RD, LD
• Janette Templeton Shelley, FNP
• Tara Shelley, ATC
• Sandy Kay Shelton

• All providers in Clinton, SC
• Psychiatric/Mental Health Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.