NPIMap

Individual provider Active NPI

Everett Lee Shaw, PA-C

  • Physician Assistant
  • Decatur, IL
National Provider Identifier
1437444163
Registry record updated Jan 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085.004037 Issued in IL
Practice address
4775 E Maryland St
Decatur, IL 62521-8820
Phone
(217) 864-3737
Fax
(217) 864-3468
NPI assigned
Jun 10, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 17, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085.004037 IL Primary

Addresses

Primary practice location

4775 E Maryland St
Decatur, IL 62521-8820

Mailing address

517 N Main St
Anna, IL 62906-1668
Phone (618) 833-4300

Other identifiers 2

IdentifierTypeStateIssuer
205790002OtherILMEDICARE PTAN
1051123OtherNCCAP NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231206000953 KY Practitioner - Physician Assistant 6406026806 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

800 Hospital Dr
Madisonville, KY 42431-1658

900 Hospital Dr
Madisonville, KY 42431-1644
Phone (270) 825-5101

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
73.88 of 100Reported as group
Quality
63.91
Improvement activities
40
Cost
77.03

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085.004037ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Health Deaconess Medical Group Inc Physician Assistant CurrentSince Jan 10, 2025 Accepting new patients
Baptist Health Deaconess Medical Group Inc CurrentSince Jan 10, 2025 Accepting new patients
Michael R Fisher DO, PSC PastSince Oct 1, 2001 Accepting new patients

Locations

800 Hospital Dr
Fl 2
Madisonville, KY 42431
Phone (270) 326-3900

900 Hospital Dr
Madisonville, KY 42431
Phone (270) 326-3900

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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 5

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": "1307664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673913600000",
    "number": "1437444163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "517 N MAIN ST",
            "city": "ANNA",
            "state": "IL",
            "postal_code": "629061668",
            "telephone_number": "618-833-4300",
            "fax_number": "618-833-9058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4775 E MARYLAND ST",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625218820",
            "telephone_number": "217-864-3737",
            "fax_number": "217-864-3468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "EVERETT",
        "middle_name": "LEE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-10",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.004037",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "205790002",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCAP NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS",
            "identifier": "1051123",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, IL

Sources for this page

Verify at the official NPI Registry.