Michael Kenneth Shaw, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

M5924 Issued in TX

Practice address

555 5TH St
Suite #1
Brookings, OR 97415-9730

Phone

(541) 412-1152

Fax

(541) 412-1842

NPI assigned

Jul 23, 2007

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 CA

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 Osteopathy

State licenses

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

{
    "created_epoch": "1185148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325721600000",
    "number": "1386844926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 5TH ST",
            "city": "BROOKINGS",
            "state": "OR",
            "postal_code": "974159730",
            "telephone_number": "541-412-1152",
            "fax_number": "541-412-1842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 5TH ST",
            "address_2": "SUITE #1",
            "city": "BROOKINGS",
            "state": "OR",
            "postal_code": "974159730",
            "telephone_number": "541-412-1152",
            "fax_number": "541-412-1842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "MICHAEL",
        "middle_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-23",
        "last_updated": "2012-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "M5924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sea View Assisted Living Community
• Seascape Family Health Care LLC
• Garrett Shannon
• Janel Shaull, RN
• Deann Shaw
• Monica Shaw
• Stephen W Shea, D.O.
• Emily Sherwood, CCC-SLP
• Emily M Shoemaker, PHARMD
• Mark Edward Silver, MD

• Internal Medicine Physician in Brookings, OR
• Providers in Brookings, OR by specialty
• Internal Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2012; 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.