Robert Mark Shideler, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

01051251A Issued in IN

Practice address

60 MDG/Sgow
101 Bodin Circle
Travis Air Force Base, CA 94533

Phone

(707) 423-5174

NPI assigned

Oct 13, 2005

Last updated

Apr 11, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523404800000",
    "number": "1588652408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 MDG/SGOW",
            "address_2": "101 BODIN CIRCLE",
            "city": "TRAVIS AIR FORCE BASE",
            "state": "CA",
            "postal_code": "94533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 MDG/SGOW",
            "address_2": "101 BODIN CIRCLE",
            "city": "TRAVIS AIR FORCE BASE",
            "state": "CA",
            "postal_code": "94533",
            "telephone_number": "707-423-5174"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "60 MDG/SGOW",
            "address_2": "101 Bodin Circle",
            "address_purpose": "LOCATION",
            "city": "Travis Air Force Base",
            "state": "CA",
            "postal_code": "94533",
            "country_code": "US",
            "telephone_number": "707-423-5174",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIDELER",
        "first_name": "ROBERT",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-13",
        "last_updated": "2018-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "01051251A",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IN",
            "license": "01051251A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nathan Unsu Davis
• Stephen Martin Golden, M.D.
• Doreen Onipede Jackson, MD
• Mary H Miller, LCSW
• James Lance Rounkles, RN
• Christopher William Walker, M.D.
• David Weeks

• Psychiatry Physician in Travis Air Force Base, CA
• Providers in Travis Air Force Base, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.