Trevecca Kerry Shaw, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

00338 Issued in KY

Practice address

2406 W Broadway
Louisville, KY 40211-1008

Phone

(502) 775-1711

Fax

(502) 443-0369

NPI assigned

Jun 25, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• PMR Ky Holding, LLC

  • Specialist
  • Miami Gardens, FL
  • NPI 1740737709

  KY

  Medicare reassignment NPD
• Mobile Medical, Inc.

  • Podiatrist
  • Perrysburg, OH
  • NPI 1003066747
  NPD (past)
• Onhealthcare LLC

  • Podiatrist
  • Indianapolis, IN
  • NPI 1952677353
  NPD (past)
• Richmond Foot & Ankle Clinic, LLC

  • Foot & Ankle Surgery Podiatrist
  • Dayton, OH
  • NPI 1861669970
  NPD (past)

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

{
    "created_epoch": "1214352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615939200000",
    "number": "1497917165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 BELMONT AVE",
            "address_2": "#1",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445041130",
            "telephone_number": "330-747-3910",
            "fax_number": "330-747-3930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2406 W BROADWAY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402111008",
            "telephone_number": "502-775-1711",
            "fax_number": "502-443-0369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "TREVECCA",
        "middle_name": "KERRY",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-25",
        "last_updated": "2021-03-17",
        "certification_date": "2021-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "KY",
            "license": "00338",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000614278",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2919864",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julia Kirsten-Cobbs Shaw, MS,OTR/L
• Kenneth R Shaw, LCSW
• Linda Shaw, CRNA
• Monica Shaw, MD
• Robert W. Shaw III, MD
• Adham Shawkat
• Shawnee Christian Healthcare Center Inc
• Shawnee Christian Healthcare Center Inc
• Shawnee Dental, PLLC.
• Shawnee Dental, PLLC.

• Foot & Ankle Surgery Podiatrist in Louisville, KY
• Providers in Louisville, KY by specialty
• Foot & Ankle Surgery Podiatrist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.