Individual provider Active NPI

Stuart Michael Shaw

  • Physical Therapist
  • Roswell, GA
National Provider Identifier
1376198960
Registry record updated Jan 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT014307 Issued in GA
Practice address
11490 Alpharetta Hwy Ste 200
Roswell, GA 30076-3866
Phone
(770) 740-8592
NPI assigned
Aug 9, 2019
Last updated
Jan 12, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 12, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT014307 GA Primary

Addresses

Primary practice location

11490 Alpharetta Hwy Ste 200
Roswell, GA 30076-3866

Mailing address

6397 Lee Hwy
Chattanooga, TN 37421-2564
Phone (678) 608-2543

Other practice location 1

11660 Alpharetta Hwy Ste 320
Roswell, GA 30076-3878
Phone (678) 608-2543

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220202000758 GA Practitioner - Physical Therapist in Private Practice 6507259249 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Nova Southeastern College of Osteo Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

11490 Alpharetta Hwy
Suite 200
Roswell, GA 30076-3866
Phone (770) 740-8592

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Practice roles

OrganizationSpecialtyStatusNew patients
Benchmark Physical Therapy, Inc CurrentSince Jan 10, 2022 Accepting new patients
Independent Physical Therapy of Georgia, LLC Physical Therapist CurrentSince Jan 10, 2022 Accepting new patients
Independent Physical Therapy of Georgia, LLC Physical Therapist CurrentSince Jan 10, 2022 Accepting new patients
Atlanta South Physical Therapy, Inc Physical Therapist CurrentSince Jan 10, 2022 Accepting new patients
Drayer Physical Therapy Georgia LLC Physical Therapist CurrentSince Jan 10, 2022 Accepting new patients

Locations

1200 Corporate Dr
Ste 400
Hoover, AL 35242
Phone (423) 238-7568

1025 E West Connector
Ste 406
Austell, GA 30106
Phone (770) 384-1001

1820 Highway 20 SE
Ste 160
Conyers, GA 30013
Phone (770) 922-9222

1689 Old Pendergrass Rd
Ste 300
Jefferson, GA 30549
Phone (706) 387-0212

7130 Mount Zion Blvd
Ste 9
Jonesboro, GA 30236
Phone (770) 603-5660

3455 Highway 81
Loganville, GA 30052
Phone (678) 635-8280

11490 Alpharetta Hwy
Ste 200
Roswell, GA 30076
Phone (770) 740-8592

6397 Lee Hwy
Ste 300
Chattanooga, TN 37421
Phone (423) 238-8923

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1565308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641945600000",
    "number": "1376198960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6397 LEE HWY",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374212564",
            "telephone_number": "678-608-2543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11490 ALPHARETTA HWY STE 200",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300763866",
            "telephone_number": "770-740-8592"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11660 Alpharetta Hwy Ste 320",
            "address_purpose": "LOCATION",
            "city": "Roswell",
            "state": "GA",
            "postal_code": "300763878",
            "country_code": "US",
            "telephone_number": "678-608-2543",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAW",
        "first_name": "STUART",
        "middle_name": "MICHAEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-08-09",
        "last_updated": "2022-01-12",
        "certification_date": "2022-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT014307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.