NPIMap

Individual provider Active NPI

Brett K Shaffer, MD

  • Anesthesiology Physician
  • Charlotte, NC
National Provider Identifier
1407242944
Registry record updated Oct 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
202102318 Issued in NC
Practice address
3735 Glenlake Dr Ste 250
Charlotte, NC 28208-6866
Phone
(704) 749-5801
NPI assigned
Apr 10, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 202102318 NC Primary
Anesthesiology Physician 207L00000X 0101264817 VA

Addresses

Primary practice location

3735 Glenlake Dr Ste 250
Charlotte, NC 28208-6866

Mailing address

3735 Glenlake Dr Ste 250
Charlotte, NC 28208-6866

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, NC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190731000350 VA Practitioner - Anesthesiology 4183926165
I20210917001405 NC Practitioner - Anesthesiology 4183926165 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Virginia School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Anesthesiology Associates PAGroup PAC ID 3971566761, 218 clinicians

Practice addresses (Care Compare)

200 Hawthorne LN
Charlotte, NC 28204-2515
Phone (704) 384-4000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
202102318NCMDAnesthesiology Physician
0101264817VAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Anesthesiology Associates, P.a. Anesthesiology CurrentSince Sep 17, 2021 Accepting new patients
Acv Inc Anesthesiology CurrentSince Jul 15, 2019 Accepting new patients
Anesthesiology Consultants of Virginia, Inc Anesthesiology PastSince Jul 15, 2019 Accepting new patients
Ambulatory Anesthesia of Pinehurst, PA Anesthesiology Past Accepting new patients

Locations

131 Providence Rd
Ste 200
Charlotte, NC 28207
Phone 70474958001101

1918 Randolph Rd
Ste 740
Charlotte, NC 28207
Phone (704) 316-0810

200 Hawthorne Ln
Charlotte, NC 28204
Phone (704) 377-2424

3735 Glenlake Dr
Ste 250
Charlotte, NC 28208
Phone (704) 749-5801

5115 Bernard Dr
Ste 201
Roanoke, VA 24018
Phone (540) 345-0289

Organizations & group practices 5

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 6

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": "1428624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666742400000",
    "number": "1407242944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3735 GLENLAKE DR STE 250",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282086866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3735 GLENLAKE DR STE 250",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282086866",
            "telephone_number": "704-749-5801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFFER",
        "first_name": "BRETT",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-10",
        "last_updated": "2022-10-26",
        "certification_date": "2022-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NC",
            "license": "202102318",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "VA",
            "license": "0101264817",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.