Wayne Shaw, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

25MA09126300 Issued in NJ

Practice address

600 Pemberton Browns Mills Rd
Pemberton, NJ 08068-1537

Phone

(609) 894-1100

NPI assigned

Jun 18, 2008

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 1

Medicare fee-for-service enrollment

Enrolled in NJ

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 Medicine

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 and National Provider Directory roles.

• Southern Jersey Family Medical Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Hammonton, NJ
  • NPI 1568473973
  Medicare reassignment NPD
• Southern Jersey Family Medical Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Salem, NJ
  • NPI 1104940493
  NPD

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

{
    "created_epoch": "1213747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591228800000",
    "number": "1407017908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 N WHITE HORSE PIKE",
            "city": "HAMMONTON",
            "state": "NJ",
            "postal_code": "080371875",
            "telephone_number": "609-567-0200",
            "fax_number": "609-567-3492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 PEMBERTON BROWNS MILLS RD",
            "city": "PEMBERTON",
            "state": "NJ",
            "postal_code": "080681537",
            "telephone_number": "609-894-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-18",
        "last_updated": "2020-06-04",
        "certification_date": "2020-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA09126300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0302457",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christiana Rutkowski, LAC
• Theresa Sager
• Gabrielle Samad
• Chitra Sarvotam, DDS
• Jessica Schurstein
• Sarah Shayka, OT
• Jeana Ann Simko, CPRS, CRSP
• Slueue LLC
• Slueue Personal Care LLC
• Slueue Personal Care LLC

• Internal Medicine Physician in Pemberton, NJ
• Providers in Pemberton, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2020; 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.