Active NPI
Paula Shivock, LAT ATC
- Athletic Trainer
- Stroudsburg, PA
National Provider Identifier
1497124143
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 12014120-4810
- Practice address
- 440 N 5TH St
Stroudsburg, PA 18360-2439 - Phone
- (570) 878-9818
- NPI assigned
- Sep 23, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | |||
| Athletic Trainer | 2255A2300X | 12014120-4810 | UT | Primary |
Addresses
Primary practice location
440 N 5TH St
Stroudsburg, PA 18360-2439
Mailing address
652 S Medical Center Dr Ste 120
St George, UT 84790-7077
Phone (570) 878-9818
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2000026336 | Other | ATHLETIC TRAINER CERTIFIED BOC | |
| 12014120-4810 | Other | UT | LICENSED ATHLETIC TRAINER |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://intermountainhealthcare.org/locations/southwest-orthopedics-and-sports-medicine/ | intermountain |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12014120-4810 | UT | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1645660800000",
"number": "1497124143",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "652 S MEDICAL CENTER DR STE 120",
"city": "ST GEORGE",
"state": "UT",
"postal_code": "847907077",
"telephone_number": "570-878-9818"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "440 N 5TH ST",
"city": "STROUDSBURG",
"state": "PA",
"postal_code": "183602439",
"telephone_number": "570-878-9818"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIVOCK",
"first_name": "PAULA",
"credential": "LAT ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-09-23",
"last_updated": "2022-02-24",
"certification_date": "2022-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "UT",
"license": "12014120-4810",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ATHLETIC TRAINER CERTIFIED BOC",
"identifier": "2000026336",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSED ATHLETIC TRAINER",
"identifier": "12014120-4810",
"state": "UT"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://intermountainhealthcare.org/locations/southwest-orthopedics-and-sports-medicine/",
"affiliation": "Y",
"affiliationName": "intermountain",
"address_1": "652 S Medical Center Dr Ste 120",
"city": "St George",
"state": "UT",
"country_code": "US",
"postal_code": "847907077",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Stroudsburg, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 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.