Tracey Shaffer, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

6823 Issued in GA

Practice address

1113 Washington Rd
Thomson, GA 30824-7523

Phone

(706) 595-7825

NPI assigned

Oct 29, 2015

Last updated

Oct 29, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

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, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Evans Dermatology, LLCGroup PAC ID 0446310023, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: tshaffer@evansderm.emadirect.md

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.

• Evans Dermatology, LLC

  • Specialist
  • Evans, GA
  • NPI 1083862577
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1446076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446076800000",
    "number": "1598137564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1218 HARDY POINTE DR",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308095281",
            "telephone_number": "706-504-4240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1113 WASHINGTON RD",
            "city": "THOMSON",
            "state": "GA",
            "postal_code": "308247523",
            "telephone_number": "706-595-7825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFFER",
        "first_name": "TRACEY",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-29",
        "last_updated": "2015-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "6823",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wanda Sanders, LPC
• Chantell Scott
• Rosalind Felecia Scott, LPC
• Second Chance Counseling Services, LLC
• Austin Jeffrey Secrist, DMD
• James Christopher Sheppard, MD
• Karen Lee Shouse, APRN-BC
• Laura W. Smith, RN
• Southern Home Care Services, Inc.
• Southern Home Care Services, Inc. (ResCare HomeCare)

• Physician Assistant in Thomson, GA
• Providers in Thomson, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2015; 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.