Shakellah Amini, M.D.
Individual provider Active NPI Family Medicine Physician · Oshkosh, WI
NPI 1598144347 · NPPES record last updated Nov 19, 2021
Key facts
- NPI
- 1598144347
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 20596 (WI)
- Practice address
- 855 N Westhaven Dr
Oshkosh, WI 54904-7668 - Phone
- (920) 303-8700
- Fax
- (920) 456-7601
- NPI assigned
- May 27, 2015
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 6
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Aurora Medical Group, Inc.
Practice addresses (Care Compare)
855 N Westhaven Dr
Oshkosh, WI 54904-7668
Phone (920) 303-8700
Hospital & facility affiliations
- Aurora Medical Ctr Oshkosh
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA, WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201224000299 | CA | Practitioner - Family Practice | 6204131782 | Reassigns benefits to 1 organization |
| I20210422001251 | WI | Practitioner - Family Practice | 6204131782 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20596 | WI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Permanente Medical Group Inc | Family Medicine | Current |
Accepting new patients |
| Permanente Medical Group Inc | Family Medicine | Current | Accepting new patients |
| Aurora Medical Group, Inc. | Family Medicine | Current |
Accepting new patients |
| Permanente Medical Group, Inc | Current |
Accepting new patients | |
| Aurora Medical Group, Inc. | Current |
Accepting new patients | |
| Aurora Medical Group, Inc. | Past | Accepting new patients |
Locations
750 Auburn Ravine Rd
Auburn, CA 95603
Phone (530) 823-6131
4753 W Shaw Ave
Ste 101
Fresno, CA 93722
Phone (559) 277-8738
900 N Douty St
Hanford, CA 93230
Phone (559) 587-9014
1800 Harrison St
Fl 7
Oakland, CA 94612
101 Monroe St
Petaluma, CA 94954
Phone (707) 763-4109
1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015
901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500
930 W Main St
Ripon, CA 95366
Phone (209) 599-4221
501 J St
Sacramento, CA 95814
Phone (916) 497-3000
2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000
710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400
5615 Scotts Valley Dr
Scotts Valley, CA 95066
Phone (831) 430-2700
2651 Highland Ave
Selma, CA 93662
Phone (559) 898-6000
7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000
975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000
320 N Crawford St
Willows, CA 95988
Phone (530) 934-2834
210 Wisconsin American Dr
Fond du Lac, WI 54937
Phone (920) 907-7000
3301 W Forest Home Ave
Milwaukee, WI 53215
Phone (414) 389-2233
1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056
855 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 451-5643
Interoperability endpoints
- samini304838@direct.myadvocateaurora.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 125066654 | IL | |
| Family Medicine Physician | 207Q00000X | 20596 | WI | Yes |
Addresses
Primary practice location
855 N Westhaven Dr
Oshkosh, WI 54904-7668
Mailing address
855 N Westhaven Dr
Oshkosh, WI 54904-7668
Phone (920) 303-8700
Other practice location 1
4140 Southwest Hwy
Hometown, IL 60456-1135
Phone (708) 422-5700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101161956 | Medicaid | WI |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/ | ||
| Direct Messaging Address | samini304838@direct.myadvocateaurora.org | Direct |
Other providers in Oshkosh, WI
- Ambulatory Surgical Center, LLC
- American Current Care P.a.
- Diane P Ames
- Richard E Ames
- Ryan P Ames
- Ams of Wisconsin LLC
- Evelyn Lauren Andersen
- Anderson Chiropractic of Oshkosh, S. C.
- Anderson Vision Center, LTD.
- Amanda Clare Anderson
All providers in Oshkosh, WI · Family Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 19, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.