NPIMap

Individual provider Active NPI

Austin James Shackelford, DMD

  • Oral and Maxillofacial Pathology Dentistry
  • Wilkes Barre, PA
National Provider Identifier
1558864140
Registry record updated Aug 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X
License
DS045082 Issued in PA
Practice address
675 Baltimore Dr
Wilkes Barre, PA 18702-7900
Phone
(570) 808-5626
Fax
(570) 808-6352
NPI assigned
Mar 9, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Pathology Dentistry 1223P0106X DS045082 PA Primary

Addresses

Primary practice location

675 Baltimore Dr
Wilkes Barre, PA 18702-7900

Mailing address

100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 808-5626

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20250917004479 PA Practitioner - Oral and Maxillofacial Pathology 0941548648 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Oral and Maxillofacial Pathology
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians

Practice addresses (Care Compare)

675 Baltimore Dr
Wilkes Barre, PA 18702-7900
Phone (570) 826-7300

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger-HM Joint Venture, LLC CurrentSince Aug 18, 2025 Accepting new patients
Geisinger Clinic CurrentSince Aug 18, 2025 Accepting new patients
Geisinger-HM Joint Venture, LLC CurrentSince Aug 18, 2025 Accepting new patients
Geisinger Clinic Current Accepting new patients
Geisinger Clinic CurrentSince Aug 18, 2025 Accepting new patients

Locations

100 N Academy Ave
Danville, PA 17822

10 Choate Cir
Montoursville, PA 17754
Phone (570) 368-5566

255 Route 220 Hwy
Muncy, PA 17756
Phone (570) 308-2600

675 Baltimore Dr
Wilkes Barre, PA 18702
Phone (570) 808-5757

Interoperability endpoints

  • Direct secure messaging: ashackelford648343@direct.geisinger.edu

Organizations & group practices 5

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 46

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1520553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755216000000",
    "number": "1558864140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "570-808-5626",
            "fax_number": "570-808-6352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 BALTIMORE DR",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187027900",
            "telephone_number": "570-808-5626",
            "fax_number": "570-808-6352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKELFORD",
        "first_name": "AUSTIN",
        "middle_name": "JAMES",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-03-09",
        "last_updated": "2025-08-15",
        "certification_date": "2025-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "PA",
            "license": "DS045082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilkes Barre, PA

Sources for this page

Verify at the official NPI Registry.