Brian Neal Shore, PA C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085002428 Issued in IL

Practice address

2110 Fox Dr
Champaign, IL 61820-7553

Phone

(217) 366-1237

NPI assigned

Aug 10, 2005

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Central Illinois Orthopedic Surgery II LLC.Group PAC ID 5991705428, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Joseph Medical Center Hospital, Bloomington, IL, CCN 140162

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Central Illinois Orthopedic Surgery II LLC.

  • Orthopaedic Surgery Physician
  • Bloomington, IL
  • NPI 1508889965
  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Joseph Medical Center

  • General Acute Care Hospital
  • Bloomington, IL
  • NPI 1619916806
  Care Compare affiliation

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426550400000",
    "number": "1376544585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 W UNIVERSITY AVE",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618203909",
            "telephone_number": "217-366-8107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2110 FOX DR",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618207553",
            "telephone_number": "217-366-1237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORE",
        "first_name": "BRIAN",
        "middle_name": "NEAL",
        "name_prefix": "Mr.",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2015-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085002428",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "434110",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00382778",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sunah Shin, MSW
• Jun Shinohara, PT
• Peter Alex Shireman
• Brandy Shirley, LCPC
• Sarah Shoemaker, CNM
• Hamutal Shpigler, MA
• Joshua Shride, ATC
• Erica Shroyer, APN, NP-C
• Ohm Shukla, EMT-B
• Alexandra Shulenburger

• Physician Assistant in Champaign, IL
• Providers in Champaign, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2015; 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.
• 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.