NPIMap

Organization Active NPI

M. Shank, M.D., PH.D., Inc.

Doing business as Diabetes and Metabolism Special1st Care

  • Endocrinology, Diabetes & Metabolism Physician
  • Lima, OH
National Provider Identifier
1558489062
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
35057234 Issued in OH
Legal business name
M. SHANK, M.D., PH.D., INC.
Doing business as
Diabetes and Metabolism Special1st Care
Practice address
715 W North St
Lima, OH 45801-3922
Phone
(419) 227-1570
Fax
(419) 227-5005
NPI assigned
Mar 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. M. Shank, M.D., PH.D.NPI 1831273069
Title
President
Phone
(419) 227-1570

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RE0101X 35057234 OH Primary

Addresses

Primary practice location

715 W North St
Lima, OH 45801-3922

Mailing address

715 W North St
Lima, OH 45801-3922
Phone (419) 227-1570

Other identifiers 1

IdentifierTypeStateIssuer
2058053MedicaidOH

Other names 1

  • Diabetes and Metabolism Special1st Care Doing business as

National Provider Directory

National Provider Directory

Locations

715 W North St
Lima, OH 45801
Phone (419) 227-1570

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1558489062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 W NORTH ST",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458013922",
            "telephone_number": "419-227-1570",
            "fax_number": "419-227-5005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 W NORTH ST",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458013922",
            "telephone_number": "419-227-1570",
            "fax_number": "419-227-5005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M. SHANK, M.D., PH.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHANK",
        "authorized_official_first_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "419-227-1570",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., PH.D."
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "OH",
            "license": "35057234",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2058053",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diabetes and Metabolism Special1st Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lima, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.