Courtney W Shelbourne, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

3426 Issued in SC

Practice address

198 Rutledge Ave
Suite 4
Charleston, SC 29403-5817

Phone

(843) 853-5859

Fax

(843) 853-5861

NPI assigned

Aug 2, 2005

Last updated

Jan 25, 2013By 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 26, 2015 through Oct 26, 2027

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Shelbourne & Associates Oral and Facial Surgery

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Charleston, SC
  • NPI 1730602319
  NPD (past) Authorized official
• Barefoot Oral and Maxillofacial Surgery LLC

  dba Barefoot Oral and Facial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Mount Pleasant, SC
  • NPI 1710377866
  NPD (past)
• Palmetto Facial Surgery Center, LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Mount Pleasant, SC
  • NPI 1992924534
  NPD (past)

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

{
    "created_epoch": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359072000000",
    "number": "1407857428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "198 RUTLEDGE AVE",
            "address_2": "SUITE 4",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294035817",
            "telephone_number": "843-853-5859",
            "fax_number": "843-853-5861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "198 RUTLEDGE AVE",
            "address_2": "SUITE 4",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294035817",
            "telephone_number": "843-853-5859",
            "fax_number": "843-853-5861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHELBOURNE",
        "first_name": "COURTNEY",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-02",
        "last_updated": "2013-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "SC",
            "license": "3426",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9641",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Jay Shebiro, DO
• Melissa Shedden, SLP
• Sarah Sheehan
• Benjamin Franklin Sheftall, DMD
• Shelbourne & Associates Oral and Facial Surgery
• William Harrison Shelley III, M.D.
• Callie Stewart Shellhaas, CRNA
• Jordan Rae Shelton, MSW
• Patrick Gene Shen, MD
• Sunil Shenvi

• Oral and Maxillofacial Surgery (Dentist) in Charleston, SC
• Providers in Charleston, SC by specialty
• Oral and Maxillofacial Surgery (Dentist) in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2013; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.