Johnathon Patrick Shaffer, MD

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

01085483A Issued in IN

Practice address

583 S Clarizz Blvd
Bloomington, IN 47401-5515

Phone

(812) 676-4460

Fax

(812) 355-4092

NPI assigned

Apr 5, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Specialty

Neurology

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Iu Health Medical Group LLCGroup PAC ID 9638617913, 4,382 clinicians

Indiana University Health Southern Indiana Physicians LLCGroup PAC ID 6204748197, 474 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Indiana University Health Bloomington Hospital Hospital, Bloomington, IN, CCN 150051
• Indiana University Health Hospital, Indianapolis, IN, CCN 150056

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jshaffer@direct.iuhealth.org
• Direct secure messaging: jshaffer8@direct.iuhealth.org

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.

• Indiana University Health Southern Indiana Physicians, LLC

  • Multi-Specialty Clinic/Center
  • Bloomington, IN
  • NPI 1013953983
  Medicare reassignment Care Compare group NPD
• Iu Health Medical Group, LLC

  • General Practice Physician
  • Indianapolis, IN
  • NPI 1326893777
  Medicare reassignment Care Compare group NPD
• Indiana University Health Southern Indiana Physicians LLC

  • Durable Medical Equipment & Medical Supplies
  • Bloomington, IN
  • NPI 1063179844
  NPD

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

• Indiana University Health Bloomington Inc

  dba Iu Health Bloomington

  • General Acute Care Hospital
  • Bloomington, IN
  • NPI 1205860335
  Care Compare affiliation
• Indiana University Health Inc

  dba Indiana University Health

  • General Acute Care Hospital
  • Indianapolis, IN
  • NPI 1144266024
  Care Compare affiliation

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

{
    "created_epoch": "1459814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722297600000",
    "number": "1598129678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "583 S CLARIZZ BLVD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474015515",
            "telephone_number": "812-676-4460",
            "fax_number": "812-355-4092"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6801 Park Ter # 250",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900451543",
            "country_code": "US",
            "telephone_number": "310-665-7200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "22 S Greene St Rm N3E09",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212011544",
            "country_code": "US",
            "telephone_number": "410-328-6110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAFFER",
        "first_name": "JOHNATHON",
        "middle_name": "PATRICK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-05",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "A167677",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IN",
            "license": "01085483A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "090540643",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PTAN",
            "identifier": "000001581445",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300053899",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jshaffer@direct.iuhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "583 S Clarizz Blvd",
            "city": "Bloomington",
            "state": "IN",
            "country_code": "US",
            "postal_code": "474015515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Alexis Sexton, RBT
• Camryn Sexton, RBT
• Eleanor Sexton
• Karen Elizabeth Shafer, MD
• Anna Shaffer
• Shana Linsey Shaffer, NP
• Hena Naz Shah, NP
• Kshitija R Shah, OTR
• Rajesh V Shah, M.D.
• Frank B Shahbahrami Jr., MD

• Neurology Physician in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Neurology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 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.