NPIMap

Individual provider Active NPI

Gary I Shapiro, MD

  • Family Medicine Physician
  • Mount Laurel, NJ
National Provider Identifier
1386610228
Registry record updated Oct 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25MA06119800 Issued in NJ
Practice address
204 Ark Rd
Suite 103
Mount Laurel, NJ 08054-3100
Phone
(856) 778-4756
Fax
(856) 778-1742
NPI assigned
Feb 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 25MA06119800 NJ Primary

Addresses

Primary practice location

204 Ark Rd
Suite 103
Mount Laurel, NJ 08054-3100

Mailing address

204 Ark Rd
Suite 103
Mount Laurel, NJ 08054-3100
Phone (856) 778-4756

Other identifiers 1

IdentifierTypeStateIssuer
6931707MedicaidNJ

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address gshapiro12135@directvirtua.org
Direct Messaging Address gshapiro12135@directvirtua.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20110708000087 NJ Practitioner - Family Practice 1850579251 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Pittsburgh School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Virtua Medical Group, PAGroup PAC ID 9830222397, 1,678 clinicians

Practice addresses (Care Compare)

3242 Route 206
Bordentown, NJ 08505-4517

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA06119800NJMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Virtua Medical Group, PA Family Medicine CurrentSince Apr 16, 2012 Accepting new patients
Virtua Medical Group, PA CurrentSince Apr 16, 2012 Accepting new patients
MLFP LLC Family Medicine PastSince May 31, 2000 Accepting new patients

Locations

3242 Route 206
Ste 2
Bordentown, NJ 08505
Phone (609) 298-4340

401 Young Ave
Ste 260A
Moorestown, NJ 08057
Phone (856) 291-8756

204 Ark Rd
Ste 103
Mount Laurel, NJ 08054
Phone (609) 778-4756

7000 Atrium Way
Ste 6
Mount Laurel, NJ 08054
Phone (856) 206-4500

Interoperability endpoints

  • Direct secure messaging: gshapiro12135@directvirtua.org

Organizations & group practices 3

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 11

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": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603065600000",
    "number": "1386610228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 ARK RD",
            "address_2": "SUITE 103",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080543100",
            "telephone_number": "856-778-4756",
            "fax_number": "856-778-1742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 ARK RD",
            "address_2": "SUITE 103",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080543100",
            "telephone_number": "856-778-4756",
            "fax_number": "856-778-1742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAPIRO",
        "first_name": "GARY",
        "middle_name": "I",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-28",
        "last_updated": "2020-10-19",
        "certification_date": "2020-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MA06119800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6931707",
            "state": "NJ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gshapiro12135@directvirtua.org",
            "affiliation": "N",
            "address_1": "204 Ark Rd",
            "address_2": "Suite 103",
            "city": "Mount Laurel",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080543100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gshapiro12135@directvirtua.org",
            "affiliation": "N",
            "address_1": "204 Ark Rd",
            "address_2": "Suite 103",
            "city": "Mount Laurel",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080543100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mount Laurel, NJ

Sources for this page

Verify at the official NPI Registry.