NPIMap

Individual provider Active NPI

Shawn A Bollinger, PA

  • Physician Assistant
  • Spartanburg, SC
National Provider Identifier
1457377616
Registry record updated Jan 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2363 Issued in SC
Practice address
225 E Wood St
Spartanburg, SC 29303-3050
Phone
(864) 560-4420
Fax
(864) 560-5296
NPI assigned
Jul 14, 2006
Last updated
Jan 12, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2363 SC Primary
Surgical Physician Assistant 363AS0400X 10000462A IN

Addresses

Primary practice location

225 E Wood St
Spartanburg, SC 29303-3050

Mailing address

PO Box 743070
Atlanta, GA 30374-3070
Phone (864) 560-4304

Other practice location 1

25 Hospital Center Blvd Ste 306
Hilton Head Island, SC 29926-2739
Phone (843) 689-8224

Other identifiers 3

IdentifierTypeStateIssuer
000000375781OtherBCBS PIN
2241PAMedicaidSC
970018928OtherRAILROAD MEDICARE PIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sbollinger162078@direct.wvuhsdirect.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, ND2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150826000295 SC Practitioner - Physician Assistant 0042359671 Reassigns benefits to 1 organization
I20240321003416 ND Practitioner - Physician Assistant 0042359671 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Medical Center FargoGroup PAC ID 8426967803, 1,210 clinicians

Practice addresses (Care Compare)

1220 Sheyenne St
West Fargo, ND 58078-2637
Phone (701) 234-4445

5225 23Rd Ave S
Fargo, ND 58104-7927
Phone (701) 417-2575

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2363SCMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center Fargo CurrentSince Feb 5, 2024 Accepting new patients
Self Medical Group CurrentSince Aug 1, 2022 Accepting new patients
Sanford Medical Center Fargo CurrentSince Feb 5, 2024 Accepting new patients
Self Medical Group CurrentSince Aug 1, 2022 Accepting new patients
Spartanburg Medical Center Past Accepting new patients
Beacon Medical Group, Inc. Past Accepting new patients

Locations

75 Remittance Dr
Dept 6764
Chicago, IL 60675

1220 Sheyenne St
West Fargo, ND 58078
Phone (701) 234-4445

2605 Kinard St
Ste 200
Newberry, SC 29108
Phone (803) 276-1866

Interoperability endpoints

  • Direct secure messaging: sbollinger538217@selfregional.direct-ci.net

Organizations & group practices 7

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.

Hospital & facility affiliations 7

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": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610409600000",
    "number": "1457377616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743070",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303743070",
            "telephone_number": "864-560-4304",
            "fax_number": "864-560-4413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 E WOOD ST",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293033050",
            "telephone_number": "864-560-4420",
            "fax_number": "864-560-5296"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "25 Hospital Center Blvd Ste 306",
            "address_purpose": "LOCATION",
            "city": "Hilton Head Island",
            "state": "SC",
            "postal_code": "299262739",
            "country_code": "US",
            "telephone_number": "843-689-8224",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLLINGER",
        "first_name": "SHAWN",
        "middle_name": "A",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "2363",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IN",
            "license": "10000462A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PIN",
            "identifier": "000000375781",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2241PA",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "970018928",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sbollinger162078@direct.wvuhsdirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1 Medical Center Dr",
            "city": "Morgantown",
            "state": "WV",
            "country_code": "US",
            "postal_code": "265061200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Spartanburg, SC

Sources for this page

Verify at the official NPI Registry.