NPIMap

Individual provider Active NPI

Brian Michael Shockey, MD

  • Internal Medicine Physician
  • Ardmore, OK
National Provider Identifier
1366404105
Registry record updated May 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
18264 Issued in OK
Practice address
2419 Chickasaw Blvd
Ardmore, OK 73401-1466
Phone
(580) 223-6767
Fax
(580) 226-2977
NPI assigned
Apr 5, 2006
Last updated
May 14, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 18264 OK Primary

Addresses

Primary practice location

2419 Chickasaw Blvd
Ardmore, OK 73401-1466

Mailing address

2419 Chickasaw Blvd
Ardmore, OK 73401-1466
Phone (580) 223-6767

Other identifiers 1

IdentifierTypeStateIssuer
100202500AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040525000526 OK Practitioner - Internal Medicine 2264413533 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Loma Linda University School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2419 Chickasaw Blvd
Ardmore, OK 73401-1466
Phone (580) 223-6767

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Ardmore, Inc. CurrentSince May 1, 2015 Accepting new patients
Mercy Clinic Oklahoma Communities Internal Medicine CurrentSince Jun 21, 2014 Accepting new patients
Shockey Internal Medicine PC Internal Medicine CurrentSince Jan 1, 2004 Accepting new patients
Mercy Hospital Ardmore, Inc Internal Medicine CurrentSince May 1, 2015 Accepting new patients
Nedley Clinic P C Internal Medicine Past Accepting new patients
Good Shepherd Hospice of Ardmore, LLC PastSince Mar 10, 2021 Accepting new patients
Mercy Hospital Ardmore, Inc. Past Accepting new patients
Summit Medical Center Past Accepting new patients
Darlene Investment Group Lakeland Manor, Inc. Past Accepting new patients

Locations

1011 14th Ave NW
Ardmore, OK 73401
Phone (580) 220-6658

2419 Chickasaw Blvd
Ardmore, OK 73401
Phone (580) 223-6767

4300 McAuley Blvd
Oklahoma City, OK 73120
Phone (405) 936-5455

4300 W Memorial Rd
Oklahoma City, OK 73120
Phone (405) 752-3962

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Good Shepherd Hospice of Ardmore, LLCArdmore, OK, CCN 371726 Hospice Corporate Director (100%)
W-2 Managing Employee		 Mar 10, 2021
Mar 10, 2021

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 9

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.

Hospital & facility affiliations 7

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": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210723200000",
    "number": "1366404105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2419 CHICKASAW BLVD",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011466",
            "telephone_number": "580-223-6767",
            "fax_number": "580-226-2977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2419 CHICKASAW BLVD",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011466",
            "telephone_number": "580-223-6767",
            "fax_number": "580-226-2977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOCKEY",
        "first_name": "BRIAN",
        "middle_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-05",
        "last_updated": "2008-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "18264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100202500A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ardmore, OK

Sources for this page

Verify at the official NPI Registry.