NPIMap

Individual provider Active NPI

Shelley D Wise, D.C.

  • Addiction (Substance Use Disorder) Counselor
  • Carmel, CA
National Provider Identifier
1578566451
Registry record updated Sep 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
R1318520818 Issued in CA
Practice address
245 Crossroads Blvd
Carmel, CA 93923-8650
Phone
(831) 373-0985
Fax
(831) 620-0711
NPI assigned
May 24, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 10, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X DC20443 CA
Addiction (Substance Use Disorder) Counselor 101YA0400X R1318520818 CA Primary

Addresses

Primary practice location

245 Crossroads Blvd
Carmel, CA 93923-8650

Mailing address

245 Crossroads Blvd
Carmel, CA 93923-8650
Phone (831) 373-0985

Other identifiers 3

IdentifierTypeStateIssuer
7703084230006OtherCACIGNA
DC0204430OtherCABLUE SHIELD
770308423OtherCABLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R1318520818CAMDAddiction (Substance Use Disorder) Counselor
DC20443CAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Carmel Orthopedic & Sports Therapy Past Accepting new patients
Carmel Orthopedic & Sports Therapy Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536537600000",
    "number": "1578566451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 CROSSROADS BLVD",
            "city": "CARMEL",
            "state": "CA",
            "postal_code": "939238650",
            "telephone_number": "831-373-0985",
            "fax_number": "831-620-0711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 CROSSROADS BLVD",
            "city": "CARMEL",
            "state": "CA",
            "postal_code": "939238650",
            "telephone_number": "831-373-0985",
            "fax_number": "831-620-0711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "SHELLEY",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-05-24",
        "last_updated": "2018-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC20443",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "R1318520818",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "7703084230006",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "DC0204430",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "770308423",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carmel, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2018; 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.