Kenton L Shaffer, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

12336 Issued in NE

Practice address

211 West 33Rd Street
Kearney, NE 68845

Phone

(308) 865-2141

Fax

(308) 234-7582

NPI assigned

Oct 25, 2006

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Interoperability endpoints

• Direct secure messaging: kenton.shaffer.1@16664.direct.athenahealth.com

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1558445320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 670",
            "city": "KEARNEY",
            "state": "NE",
            "postal_code": "68848",
            "telephone_number": "308-865-2141",
            "fax_number": "308-234-7582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 WEST 33RD STREET",
            "city": "KEARNEY",
            "state": "NE",
            "postal_code": "68845",
            "telephone_number": "308-865-2141",
            "fax_number": "308-234-7582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFFER",
        "first_name": "KENTON",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NE",
            "license": "12336",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "07365",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47064194537",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Seward, OTA
• Kelly Jo Shada, R.N.,L.M.H.P.
• Ellen Katherine Shafer-Lind, LMSW
• Angela Shafer
• Brylee Shafer
• Robert R Shaffer, M.D.
• John Paul Shandera, CRNA
• Sharon B Bond MD PC
• Linda Kay Shaw
• James D Sheen, D.C.

• Pediatrics Physician in Kearney, NE
• Providers in Kearney, NE by specialty
• Pediatrics Physician in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.