Colleen Shaw, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

0852001PA Issued in NY

Practice address

400 N Perry St
Johnstown, NY 12095-1115

Phone

(518) 736-1911

Fax

(518) 736-1923

NPI assigned

Mar 8, 2007

Sex

Female

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 4

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Planned Parenthood of Greater New York Inc

  • Ambulatory Family Planning Facility
  • Brooklyn, NY
  • NPI 1417959701
  Medicare reassignment
• Planned Parenthood of the Southern Finger Lakes Inc.

  • Ambulatory Family Planning Facility
  • Ithaca, NY
  • NPI 1881761484
  NPD (past)

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329696000000",
    "number": "1538290614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 N PERRY ST",
            "city": "JOHNSTOWN",
            "state": "NY",
            "postal_code": "120951115",
            "telephone_number": "518-736-1911",
            "fax_number": "518-736-1923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N PERRY ST",
            "city": "JOHNSTOWN",
            "state": "NY",
            "postal_code": "120951115",
            "telephone_number": "518-736-1911",
            "fax_number": "518-736-1923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "COLLEEN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-08",
        "last_updated": "2012-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "0852001PA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP HEALTHPLAN",
            "identifier": "346851",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LISCENSE",
            "identifier": "0852001PA",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000414322001",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00473643",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cathie Nicole Savage, RN
• Parul Saxena, M.D.
• Lori L Schriner, FNP
• Bernard Lawrence Schroeder, OTR
• Danielle Marie Schroeder, PHARMD
• Simply the Best Home Care, LLC
• Simplythebest Home Care LLC.
• Courtney Lynn Sitterly, REGISTERED NURSE
• Doreen M Smith
• Andrea Jean Smrtic, PHARMD

• Medical Physician Assistant in Johnstown, NY
• Providers in Johnstown, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2012; 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.