Jacob Winton Shaw, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

10825 Issued in SC

Practice address

213 W Liberty St
Winnsboro, SC 29180-1421

Phone

(803) 635-2414

NPI assigned

Jul 1, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

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.

• Physician'S Pain and Spine Center, LLC

  • Interventional Pain Medicine Physician
  • West Coumbia, SC
  • NPI 1336475573
  NPD (past)

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

{
    "created_epoch": "1404172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441065600000",
    "number": "1356757140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 W LIBERTY ST",
            "city": "WINNSBORO",
            "state": "SC",
            "postal_code": "291801421",
            "telephone_number": "803-635-2414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 W LIBERTY ST",
            "city": "WINNSBORO",
            "state": "SC",
            "postal_code": "291801421",
            "telephone_number": "803-635-2414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "JACOB",
        "middle_name": "WINTON",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-01",
        "last_updated": "2015-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SC",
            "license": "10825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerelyn S Russell
• Melisa Russell
• SC Department of Juvenile Justice
• Mary Ann Seegars, PTA
• Mark Edward Shaffer, MD
• Donna Denise Shealy, LPN, OTR
• Shealytherapeutics
• Patricia Denese Shuford, RN
• Justin Montoro Simpson, ATC
• Deborah Dianne Sloss, RN

• Nurse Practitioner in Winnsboro, SC
• Providers in Winnsboro, SC by specialty
• Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 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.

Verify at the official NPI Registry.