Individual provider Active NPI

Quan Zhen Shi, PHD

  • Psychologist
  • Bangor, ME
National Provider Identifier
1487601670
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PS884 Issued in ME
Practice address
29 Franklin St
Bangor, ME 04401-4909
Phone
(207) 942-3816
Fax
(207) 561-4725
NPI assigned
May 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PS884 ME Primary

Addresses

Primary practice location

29 Franklin St
Bangor, ME 04401-4909

Mailing address

29 Franklin St
Bangor, ME 04401-4909
Phone (207) 942-3816

Other identifiers 2

IdentifierTypeStateIssuer
214240099MedicaidME
098303OtherMEANTHEM LEGACY NUMBER

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)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PS884MEMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Occupational Exchange, Inc Psychologist PastSince Aug 13, 2004 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1487601670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 FRANKLIN ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014909",
            "telephone_number": "207-942-3816",
            "fax_number": "207-561-4725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 FRANKLIN ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014909",
            "telephone_number": "207-942-3816",
            "fax_number": "207-561-4725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHI",
        "first_name": "QUAN",
        "middle_name": "ZHEN",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "ME",
            "license": "PS884",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "214240099",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM  LEGACY NUMBER",
            "identifier": "098303",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.