Marney Blake Shattuck, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA8569 Issued in MA

Practice address

139 Turnpike Rd
Westborough, MA 01581-2835

Phone

(508) 882-7300

NPI assigned

Dec 30, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MA

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

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Urgent Care Centers of Central Massachusetts LLCGroup PAC ID 1557639366, 18 clinicians

Umass Memorial Medical Group IncGroup PAC ID 4284539891, 2,494 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Umass Memorial Healthalliance Hospitals Hospital, Leominster, MA, CCN 220001

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as apm

Quality

82.98

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Urgent Care Centers of Central Massachusetts, LLC

  dba CareWell Urgent Care

  • Urgent Care Clinic/Center
  • Marlborough, MA
  • NPI 1497286280
  Medicare reassignment Care Compare group NPD
• Umass Memorial Medical Group Inc

  • Internal Medicine Physician
  • Worcester, MA
  • NPI 1760445373
  Medicare reassignment Care Compare group
• Convenientmd - FFS UC LLC

  • Urgent Care Clinic/Center
  • Worcester, MA
  • NPI 1790528628
  Medicare reassignment
• Convenientmd - FFS UC LLC

  • Urgent Care Clinic/Center
  • Hudson, MA
  • NPI 1265227441
  NPD
• Convenientmd - FFS UC LLC

  • Urgent Care Clinic/Center
  • Sturbridge, MA
  • NPI 1386526192
  NPD
• Umass Memorial Medical Group, Inc.

  dba Urgent Care Express at Harrington

  • Urgent Care Clinic/Center
  • Oxford, MA
  • NPI 1982381018
  NPD
• Urgent Care Centers of Central Massachusetts, LLC

  dba CareWell Urgent Care

  • Urgent Care Clinic/Center
  • Northborough, MA
  • NPI 1417488206
  NPD
• Convenientmd - FFS UC LLC

  • Urgent Care Clinic/Center
  • Westborough, MA
  • NPI 1760173140
  NPD (past)
• Convenientmd LLC

  • Urgent Care Clinic/Center
  • Newburyport, MA
  • NPI 1316428824
  NPD (past)
• Convenientmd LLC

  • Urgent Care Clinic/Center
  • Westborough, MA
  • NPI 1437736675
  NPD (past)

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

• Umass Memorial Healthalliance Clinton Hospital Inc

  • General Acute Care Hospital
  • Leominster, MA
  • NPI 1013995133
  Care Compare affiliation
• Umass Memorial Healthalliance Clinton Hospital Inc

  • Psychiatric Hospital Unit
  • Clinton, MA
  • NPI 1285171934
  Care Compare affiliation

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

{
    "created_epoch": "1609286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715644800000",
    "number": "1568059004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 US HIGHWAY 1 BYP UNIT 102",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038017105",
            "telephone_number": "603-410-6700",
            "fax_number": "603-319-8308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 TURNPIKE RD",
            "city": "WESTBOROUGH",
            "state": "MA",
            "postal_code": "015812835",
            "telephone_number": "508-882-7300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "55 Lake Ave N",
            "address_purpose": "LOCATION",
            "city": "Worcester",
            "state": "MA",
            "postal_code": "016550002",
            "country_code": "US",
            "telephone_number": "508-421-1400",
            "fax_number": "508-421-1490",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHATTUCK",
        "first_name": "MARNEY",
        "middle_name": "BLAKE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-30",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA8569",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MA",
            "license": "PA8569",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110183157A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sent Angels Homecare Agency Inc
• Esha Shah
• Suzanne M Shannahan, NP
• Shaquan Read Counseling, LLC (ShaQuan Read Counseling)
• Shaquan Read Counseling, LLC
• Susan E Shawver-Matthews, MD
• Hajra O Sheikh, DMD
• Mynette Shifman, NP
• Susan Elizabeth Shih, M.D.
• Mohini Shinde, DMD

• Medical Physician Assistant in Westborough, MA
• Providers in Westborough, MA by specialty
• Medical Physician Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.