Andrew John Shadrach, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036162030 Issued in IL

Practice address

530 NE Glen Oak Ave
Peoria, IL 61637-1003

Phone

(309) 655-2000

NPI assigned

Mar 19, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

McLaren Hospital GroupGroup PAC ID 2365968351, 366 clinicians

McLaren Bay RegionGroup PAC ID 5597659011, 110 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• McLaren Bay Region Hospital, Bay City, MI, CCN 230041
• McLaren Central Michigan Hospital, Mount Pleasant, MI, CCN 230080

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• McLaren Bay Region

  • Family Medicine Physician
  • Bay City, MI
  • NPI 1508131087
  Medicare reassignment Care Compare group NPD
• McLaren Hospital Group

  • Emergency Medicine Physician
  • Flint, MI
  • NPI 1942026174
  Medicare reassignment Care Compare group
• McLaren Bay Region

  • Psychiatry Physician
  • Bay City, MI
  • NPI 1942560339
  NPD
• McLaren Bay Region

  • Psychologist
  • Essexville, MI
  • NPI 1013056233
  NPD (past)
• McLaren Bay Region

  • General Acute Care Hospital
  • Bay City, MI
  • NPI 1528031226
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• McLaren Bay Region

  • General Acute Care Hospital
  • Bay City, MI
  • NPI 1528031226
  Care Compare affiliation
• McLaren Central Michigan

  • Rural Acute Care Hospital
  • Mt Pleasant, MI
  • NPI 1619941317
  Care Compare affiliation

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

{
    "created_epoch": "1521417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687910400000",
    "number": "1467956169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 NE GLEN OAK AVE ROOM 2670",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-655-3971",
            "fax_number": "309-655-3630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616371003",
            "telephone_number": "309-655-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHADRACH",
        "first_name": "ANDREW",
        "middle_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-03-19",
        "last_updated": "2023-06-28",
        "certification_date": "2023-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036162030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard McKinley Setzer, MSW, LSW
• Sheraden K Seward, D.O.
• Linda Marie Sewell Wilson, RPH, PHARMD
• Hady Sfeir
• Katherine Mae Shadid, DMD
• Mildred Elaine Shafer, APN
• Terri Fran Shafer, LCPC
• Mary Shah-Cox, D.D.S.
• Anushi Shah, M.D.
• Darshana Vijay Shah, HOME CARE PROVIDER

• Family Medicine Physician in Peoria, IL
• Providers in Peoria, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2023; 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.