Shenandoah Medical Care Center

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

2602122

Legal business name

SHENANDOAH MEDICAL CARE CENTER

Practice address

6234 S Congress Ave
Suite F-1
Lantana, FL 33462-2307

Phone

(561) 619-9510

NPI assigned

Jan 19, 2017

Organization subpart

No

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

Authorized official

Name

Miss Joy L Fuller, ARNP

Title

Owner

Phone

(561) 853-7233

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Shenandoah Medical Care Center

  • Primary Care Clinic/Center
  • Boynton Beach, FL
  • NPI 1740608801

  O20230712004163

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/23521/brand/1/csg/1/fhir/r4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joy Lee Mowett-Fuller, DNP, AAPRN, FNP-BC

  • Family Nurse Practitioner
  • Lantana, FL
  • NPI 1720228208
  Medicare reassignment

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

{
    "created_epoch": "1484784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484784000000",
    "number": "1417494154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 741424",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334741424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6234 S CONGRESS AVE",
            "address_2": "SUITE F-1",
            "city": "LANTANA",
            "state": "FL",
            "postal_code": "334622307",
            "telephone_number": "561-619-9510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHENANDOAH MEDICAL CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-19",
        "last_updated": "2017-01-19",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "JOY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "561-853-7233",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": "2602122",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010866400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Scott Dunham Medical Supply LLC
• Senior Health Care Services, Inc. (Senior Healthcare Services)
• Serenity Rose Mobile Spa Inc (Serenity Rose Massage & Wellness)
• Lori A Sevald, MD
• Kathryn L Sheehan, RRT
• Shift and Co LLC
• Heather Christine Shirm, MSW, LCSW
• Cheryl Singer
• Erin Slopey
• Arquilla P. Smith, RPH

• Primary Care Clinic/Center in Lantana, FL
• Providers in Lantana, FL by specialty
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.