Active NPI
Willis Dresdale Shook III, MD
- Surgery Physician
- Pittsburgh, PA
National Provider Identifier
1366518367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- MD015718E
- Practice address
- 1350 Locust Street
Suite 410
Pittsburgh, PA 15219 - Phone
- (412) 562-3320
- Fax
- (412) 562-3341
- NPI assigned
- Nov 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | MD015718E | PA | Primary |
Addresses
Primary practice location
1350 Locust Street
Suite 410
Pittsburgh, PA 15219
Mailing address
1350 Locust Street
Suite 410
Pittsburgh, PA 15219
Phone (412) 562-3320
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0006206500002 | Medicaid | PA |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD015718E | PA | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Windber Hospital, Inc. | 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 and National Provider Directory roles.
-
- General Acute Care Hospital
- Windber, PA
- NPI 1275620536
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1469491200000",
"number": "1366518367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1350 LOCUST STREET",
"address_2": "SUITE 410",
"city": "PITTSBURGH",
"state": "PA",
"postal_code": "15219",
"telephone_number": "412-562-3320",
"fax_number": "412-562-3341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1350 LOCUST STREET",
"address_2": "SUITE 410",
"city": "PITTSBURGH",
"state": "PA",
"postal_code": "15219",
"telephone_number": "412-562-3320",
"fax_number": "412-562-3341"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHOOK",
"first_name": "WILLIS",
"middle_name": "DRESDALE",
"name_suffix": "III",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-28",
"last_updated": "2016-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "PA",
"license": "MD015718E",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0006206500002",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pittsburgh, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.