NPIMap

Individual provider Active NPI

Everett Patrick Shareck Jr.

  • Emergency Medicine Physician
  • Willows, CA
National Provider Identifier
1497791404
Registry record updated Aug 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
G40509 Issued in CA
Practice address
1133 W Sycamore Street
Willows, CA 95988
Phone
(530) 934-1800
Fax
(530) 934-1865
NPI assigned
Jun 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X G40509 CA Primary

Addresses

Primary practice location

1133 W Sycamore Street
Willows, CA 95988

Mailing address

PO Box 8117
Red Bluff, CA 96080
Phone (530) 529-1306

Other identifiers 1

IdentifierTypeStateIssuer
00G405090MedicaidCA

Other names 1

  • Dr. Everett Patrick Shareck Professional name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050131000918 CA Practitioner - Internal MedicinePractitioner - Emergency Medicine 3971553504 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Icahn School of Medicine at Mount Sinai, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

173 E Webster St
Colusa, CA 95932-2949
Phone (209) 287-6308

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
40509CAMDMarriage & Family Therapist
G40509CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
American Specialty Physicians Group Inc Emergency Medicine CurrentSince Jan 3, 2024 Accepting new patients
Glenn Medical Center, LLC CurrentSince Apr 16, 2014 Accepting new patients
Glenn Medical Center, LLC Current Accepting new patients
Glenn Medical Center, LLC CurrentSince Apr 16, 2014 Accepting new patients
Sierra Rural Physicians, Inc. Emergency Medicine Past Accepting new patients
Valley Emergency Physicians Emergency Medicine Past Accepting new patients
Central California Radiology Associates Inc Past Accepting new patients
Regional Radiological Associates, Inc. a Medical Group Past Accepting new patients

Locations

1191 Phelps Ave
Coalinga, CA 93210
Phone (559) 897-5841

151 E Webster St
Ste B
Colusa, CA 95932
Phone (209) 287-6308

700 17th St
Ste 205
Modesto, CA 95354
Phone (209) 248-7851

1133 W Sycamore St
Willows, CA 95988
Phone (530) 934-1800

Organizations & group practices 8

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.

Hospital & facility affiliations 1

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": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1218672000000",
    "number": "1497791404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8117",
            "city": "RED BLUFF",
            "state": "CA",
            "postal_code": "96080",
            "telephone_number": "530-529-1306",
            "fax_number": "530-529-4951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 W SYCAMORE STREET",
            "city": "WILLOWS",
            "state": "CA",
            "postal_code": "95988",
            "telephone_number": "530-934-1800",
            "fax_number": "530-934-1865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHARECK",
        "first_name": "EVERETT",
        "middle_name": "PATRICK",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-20",
        "last_updated": "2008-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "G40509",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G405090",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EVERETT",
            "last_name": "SHARECK",
            "middle_name": "PATRICK",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Willows, CA

Sources for this page

Verify at the official NPI Registry.