Individual provider Active NPI

Shanta L. Griffin, DPM

  • Podiatrist
  • Memphis, TN
National Provider Identifier
1588827109
Registry record updated May 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
711 Issued in TN
Practice address
1750 Madison Ave
Suite 260
Memphis, TN 38104-6492
Phone
(901) 500-5103
Fax
(901) 310-9117
NPI assigned
Jul 3, 2008
Last updated
May 3, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 3, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 252 AR
Podiatrist 213E00000X 711 TN Primary
Foot & Ankle Surgery Podiatrist 213ES0103X POD001121 GA
Foot & Ankle Surgery Podiatrist 213ES0103X 711 TN

Addresses

Primary practice location

1750 Madison Ave
Suite 260
Memphis, TN 38104-6492

Mailing address

PO Box 21
Southaven, MS 38671-0001
Phone (901) 500-5103

Other identifiers 2

IdentifierTypeStateIssuer
1521566MedicaidTN
103I482540OtherTNMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, AR, MS, AL4 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20101108000551 TN Practitioner - Podiatry 1951596634 Reassigns benefits to 1 organization
I20130909000722 AR Practitioner - Podiatry 1951596634 Reassigns benefits to 1 organization
I20140225000659 MS Practitioner - Podiatry 1951596634 Reassigns benefits to 1 organization
I20200513002822 AL Practitioner - Podiatry 1951596634

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
William M. Scholl College of Podiatric Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1750 Madison Ave
Suite 260
Memphis, TN 38104-6458
Phone (901) 500-5103

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of nail tissue14

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
711TNMDSpecialist
252ARMDPodiatrist
POD001121GAMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Total Foot Care, Inc. of Tennessee Single Specialty PastSince Feb 1, 2007 Accepting new patients
We Heel the Sole Podiatry LLC Single Specialty PastSince Oct 12, 2016 Accepting new patients
Preferred Podiatry Group PC Single Specialty Past Accepting new patients

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1215043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651536000000",
    "number": "1588827109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 21",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386710001",
            "telephone_number": "901-500-5103",
            "fax_number": "901-310-9117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 MADISON AVE",
            "address_2": "SUITE 260",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381046492",
            "telephone_number": "901-500-5103",
            "fax_number": "901-310-9117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIFFIN",
        "first_name": "SHANTA",
        "middle_name": "L.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-03",
        "last_updated": "2022-05-03",
        "certification_date": "2022-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "AR",
            "license": "252",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "TN",
            "license": "711",
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "GA",
            "license": "POD001121",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "TN",
            "license": "711",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1521566",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "103I482540",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.