Individual provider Active NPI

Shawn M Cothran

  • In Home Supportive Care Agency
  • Wake Forest, NC
National Provider Identifier
1437870003
Registry record updated Sep 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
Practice address
120 Capcom Ave Ste 103
Wake Forest, NC 27587-6537
Phone
(919) 554-2223
Fax
(919) 457-1492
NPI assigned
Sep 12, 2022
Last updated
Sep 12, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 12, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
In Home Supportive Care Agency 253Z00000X Primary

Addresses

Primary practice location

120 Capcom Ave Ste 103
Wake Forest, NC 27587-6537

Mailing address

120 Capcom Ave Ste 103
Wake Forest, NC 27587-6537
Phone (919) 554-2223

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Cothran Innovations LLC In Home Supportive Care CurrentSince Oct 30, 2022 Accepting new patients
Cothran Innovations LLC In Home Supportive Care Current Accepting new patients

Locations

120 Capcom Ave
Ste 103
Wake Forest, NC 27587
Phone (708) 543-4310

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1662940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662940800000",
    "number": "1437870003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 CAPCOM AVE STE 103",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275876537",
            "telephone_number": "919-554-2223",
            "fax_number": "919-457-1492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 CAPCOM AVE STE 103",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275876537",
            "telephone_number": "919-554-2223",
            "fax_number": "919-457-1492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COTHRAN",
        "first_name": "SHAWN",
        "middle_name": "M",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-09-12",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wake Forest, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.