John Shalley Carroll, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

36 001951 Issued in OH

Practice address

609 Ford St
Maumee, OH 43537-1947

Phone

(419) 893-5539

Fax

(419) 893-6853

NPI assigned

Jul 20, 2005

Last updated

Feb 12, 2010By the provider in NPPES

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 3

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Kent State University College of Podiatric Medicine, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

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.

• Podiatric Associates of Northwest Ohio, LLC

  • Podiatrist
  • Maumee, OH
  • NPI 1588664296
  Medicare reassignment NPD Authorized official
• Podiatric Associates of Northwest Ohio, Inc.

  • Podiatrist
  • Wauseon, OH
  • NPI 1700897113
  Authorized official Same address or phone
• Podiatric Associates of Northwest Ohio, LLC

  • Foot & Ankle Surgery Podiatrist
  • Toledo, OH
  • NPI 1396535191
  NPD
• Podiatric Associates of Northwest Ohio, LLC

  dba Podiatric Associates of NW Ohio, Inc

  • Podiatrist
  • Toledo, OH
  • NPI 1598776981
  NPD (past)

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

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265932800000",
    "number": "1417956483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 FORD ST",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435371947",
            "telephone_number": "419-893-5539",
            "fax_number": "419-893-6853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 FORD ST",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435371947",
            "telephone_number": "419-893-5539",
            "fax_number": "419-893-6853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "JOHN",
        "middle_name": "SHALLEY",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-20",
        "last_updated": "2010-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "OH",
            "license": "36  001951",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0447047",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000135410",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARAMOUNT",
            "identifier": "00059",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Careline Poh100 LLC (Careline Physician Services)
• Joellen M Carey, COTA/L
• Melinda Isabel Carmona
• Stephanie Carnicom, BCBA, COBA, MED
• Kirsti Lynne Carr, LPC
• Marcia K Carroll, CRNA
• William J. Carroll, D.D.S.
• Justin Carter
• Tiffany Carter
• Alexa Ann Casper, MS, BCBA, COBA

• Podiatrist in Maumee, OH
• Providers in Maumee, OH by specialty
• Podiatrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2010; 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.
• 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.