Brian D. Shaw, CM

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

5606C Issued in AR

Practice address

204 Mississippi St S
Wynne, AR 72396-3025

Phone

(870) 208-8499

Fax

(870) 208-8044

NPI assigned

Jun 12, 2007

Last updated

Dec 30, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 AR

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Changes Behavioral Health, LLC

  • Community/Behavioral Health Agency
  • Wynne, AR
  • NPI 1114260486
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1419897600000",
    "number": "1396949517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 MISSISSIPPI ST S",
            "city": "WYNNE",
            "state": "AR",
            "postal_code": "723963025",
            "telephone_number": "870-208-8499",
            "fax_number": "870-208-8044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 MISSISSIPPI ST S",
            "city": "WYNNE",
            "state": "AR",
            "postal_code": "723963025",
            "telephone_number": "870-208-8499",
            "fax_number": "870-208-8044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "BRIAN",
        "middle_name": "D.",
        "credential": "CM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-12",
        "last_updated": "2014-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "5606C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rhoschandra Lakisha Scott
• Carson Sellers
• Joshua Wayne Sharp, OT
• Samantha Sharp, LPC-S
• Vicki Sharp, OTR
• Deena Ann Shaw, LPC
• Edith Renee Sherman, LCSW
• Hannah Shipp, QBHP
• Victoria L Sides
• Dalisha Lareece Smith, MHPP

• Clinical Social Worker in Wynne, AR
• Providers in Wynne, AR by specialty
• Clinical Social Worker in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2014; 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.