Shane O'Brien, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

303137 Issued in NY

Practice address

1455 E Ridge Rd
Rochester, NY 14621-2006

Phone

(585) 922-2575

Fax

(585) 922-5033

NPI assigned

Apr 14, 2017

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

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: so'brien@genesispediatrics.medentdirect.com
• Direct secure messaging: dro'brien@penfieldpediatrics.medentdirect.com

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.

• Rochester General Hospital

  • Family Medicine Physician
  • Rochester, NY
  • NPI 1356412712

  Pediatrics

  Medicare reassignment NPD
• Rochester General Hospital

  • General Acute Care Hospital
  • Rochester, NY
  • NPI 1255360517
  NPD
• Penfield Pediatrics, LLC

  • Pediatrics Physician
  • Penfield, NY
  • NPI 1629159496
  NPD (past)

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

{
    "created_epoch": "1492128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593561600000",
    "number": "1366976524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1455 E RIDGE RD",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146212006",
            "telephone_number": "585-922-2575",
            "fax_number": "585-922-5033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1455 E RIDGE RD",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146212006",
            "telephone_number": "585-922-2575",
            "fax_number": "585-922-5033"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 Elmwood Ave",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "NY",
            "postal_code": "146420001",
            "country_code": "US",
            "telephone_number": "585-275-4174",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "O'BRIEN",
        "first_name": "SHANE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-14",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "303137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen O'Brien, RPH
• Kathleen O'Brien
• Lorna A. O'Brien, RN
• Rosalie Margaret O'Brien
• Sara Elizabeth O'Brien, NP
• Susan O'Brien, CASAC
• Elya T O'Bryan, LMHC
• Ashley Paige O'Connell Ferster, M.D.
• Avice M O'Connell, M.D.
• Jennifer O'Connell

• Pediatrics Physician in Rochester, NY
• Providers in Rochester, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.