Active NPI
Joseph Roman Shields, IDC
- Independent Duty Corpsman
- San Diego, CA
National Provider Identifier
1497280929
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Independent Duty Corpsman
- License
- SP409958
- Practice address
- 3166 Barnett Ave
San Diego, CA 92110-4204 - Phone
- (619) 876-6546
- NPI assigned
- Apr 21, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Independent Duty Corpsman | 1710I1002X | SP409958 | OH | Primary |
Addresses
Primary practice location
3166 Barnett Ave
San Diego, CA 92110-4204
Mailing address
3166 Barnett Ave
San Diego, CA 92110-4204
Phone (619) 876-6546
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 |
|---|---|---|---|
| SP409958 | OH | MD | Independent Duty Corpsman |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492732800000",
"number": "1497280929",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3166 BARNETT AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921104204",
"telephone_number": "619-876-6546"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3166 BARNETT AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921104204",
"telephone_number": "619-876-6546"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIELDS",
"first_name": "JOSEPH",
"middle_name": "ROMAN",
"credential": "IDC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-04-21",
"last_updated": "2017-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "1710I1002X",
"taxonomy_group": "",
"desc": "Military Health Care Provider, Independent Duty Corpsman",
"state": "OH",
"license": "SP409958",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.