NPIMap

Individual provider Active NPI

Charlotte L Shackelford, PAC

  • Physician Assistant
  • Purcell, OK
National Provider Identifier
1366601015
Registry record updated Jul 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
746 Issued in OK
Practice address
1401 N 4TH Ave
Suite 201
Purcell, OK 73080-1806
Phone
(405) 527-5400
Fax
(405) 527-7332
NPI assigned
Jun 7, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 746 OK Primary

Addresses

Primary practice location

1401 N 4TH Ave
Suite 201
Purcell, OK 73080-1806

Mailing address

1401 N 4TH Ave
Suite 201
Purcell, OK 73080-1806
Phone (405) 527-5400

Other identifiers 2

IdentifierTypeStateIssuer
P00844211OtherRRMCARE THRU PFP
200229210AMedicaidOK

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
I20100720001038 OK Practitioner - Physician Assistant 4880726256 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Saints Medical Group, LLCGroup PAC ID 7012914898, 430 clinicians

Practice addresses (Care Compare)

608 NW 9TH St
Oklahoma City, OK 73102-1049

999 Hospital Dr
Purcell, OK 73080-1742
Phone (405) 803-5010

Hospital & facility affiliations

  • Loving Care in-Home Health Services, L.L.C. Home health agency, Noble, OK, CCN 377604
  • Purcell Municipal Hospital Hospital, Purcell, OK, CCN 370158
  • Norman Regional Hospital, Norman, OK, CCN 370008
  • SSM Health St Anthony Hospital - Oklahoma City Hospital, Oklahoma City, OK, CCN 370037
  • O U Medical Center Hospital, Oklahoma City, OK, CCN 370093
  • SSM Health St Anthony Hospital - Shawnee Hospital, Shawnee, OK, CCN 370149

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
746OKMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Saints Medical Group, LLC CurrentSince Feb 1, 2020 Accepting new patients
Purcell Municipal Hospital CurrentSince Mar 20, 2016 Accepting new patients
Purcell Municipal Hospital CurrentSince Mar 20, 2016 Accepting new patients
Saints Medical Group, LLC CurrentSince Feb 1, 2020 Accepting new patients

Locations

608 NW 9th St
Ste 2200
Oklahoma City, OK 73102
Phone (405) 231-3737

777 NW 63rd St
Fl 4
Oklahoma City, OK 73116
Phone (405) 231-3818

1500 N Green Ave
Purcell, OK 73080
Phone (405) 527-2250

1401 N 4th Ave
Ste 201
Purcell, OK 73080
Phone (405) 527-2220

1401 N 4th Ave
Ste 107
Purcell, OK 73080
Phone (405) 527-5400

999 Hospital Dr
Purcell, OK 73080
Phone (405) 803-5010

Organizations & group practices 5

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.

Hospital & facility affiliations 8

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": "1212796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310947200000",
    "number": "1366601015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 N 4TH AVE",
            "address_2": "SUITE 201",
            "city": "PURCELL",
            "state": "OK",
            "postal_code": "730801806",
            "telephone_number": "405-527-5400",
            "fax_number": "405-527-7332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 N 4TH AVE",
            "address_2": "SUITE 201",
            "city": "PURCELL",
            "state": "OK",
            "postal_code": "730801806",
            "telephone_number": "405-527-5400",
            "fax_number": "405-527-7332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKELFORD",
        "first_name": "CHARLOTTE",
        "middle_name": "L",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-07",
        "last_updated": "2011-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "746",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMCARE THRU PFP",
            "identifier": "P00844211",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200229210A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Purcell, OK

Sources for this page

Verify at the official NPI Registry.