NPIMap

Individual provider Active NPI

Shayna Kamin, DO

  • Geriatric Medicine (Family Medicine) Physician
  • Appleton, WI
National Provider Identifier
1609281567
Registry record updated Jul 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
69714 Issued in WI
Practice address
2600 S Heritage Woods Dr
Appleton, WI 54915-1408
Phone
(920) 225-7875
Fax
(920) 993-5003
NPI assigned
Jun 30, 2014
Last updated
Jul 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X TP14078 ME
Geriatric Medicine (Family Medicine) Physician 207QG0300X 69714 WI Primary

Addresses

Primary practice location

2600 S Heritage Woods Dr
Appleton, WI 54915-1408

Mailing address

3 Neenah Ctr
Neenah, WI 54956-3070
Phone (920) 225-7875

Other practice location 1

824 Illinois Ave
Stevens Point, WI 54481
Phone (715) 346-5000

Other practice location 2

2727 Plaza Dr
Wausau, WI 54401-4192
Phone (715) 847-3450

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180813000003 WI Practitioner - Family PracticePractitioner - Geriatric Medicine 0547486367 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Geriatric Medicine
Education
University of New England, College of Osteo Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

2600 S Heritage Woods Dr
Appleton, WI 54915-1408
Phone (920) 225-7875

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
TP14078MEMDFamily Medicine Physician
69714WIMDGeriatric Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
MCHS Hospitals Inc Current Accepting new patients
Thedacare, Incorporated CurrentSince Jul 20, 2024 Accepting new patients
Thedacare, Incorporated Family Medicine CurrentSince Jul 20, 2024 Accepting new patients
Aspirus Stevens Point Hospital & Clinics, Inc. CurrentSince Aug 19, 2018 Accepting new patients
MCHS Hospitals Inc CurrentSince Sep 14, 2020 Accepting new patients
Aspirus Stevens Point Hospital & Clinics, Inc. CurrentSince Aug 19, 2018 Accepting new patients
Marshfield Clinic Inc CurrentSince Sep 14, 2020 Accepting new patients
MCHS Hospitals Inc CurrentSince Sep 14, 2020 Accepting new patients
Cloverleaf Healthcare LLC PastSince Nov 1, 2024 Accepting new patients
Thedacare Medical Center - Berlin, Inc. Past Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

1000 Starr Ave
Eau Claire, WI 54703
Phone (715) 858-4850

3501 Golf Rd
Eau Claire, WI 54701
Phone (715) 858-4200

1000 N Oak Ave
Marshfield, WI 54449
Phone (715) 387-5111

3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229

600 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 237-5000

824 Illinois Ave
Stevens Point, WI 54481
Phone (715) 342-7500

900 Illinois Ave
Stevens Point, WI 54481
Phone (715) 342-7500

2727 Plaza Dr
Wausau, WI 54401
Phone (715) 847-3000

3605 Stewart Ave
Wausau, WI 54401
Phone (715) 847-0800

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/67ff075a-8289-4f2d-a8eb-5dc1f0d954ab/
  • Direct secure messaging: shayna.shackford@marshfieldclinichealthsystem.cernerdirect.com
  • Direct secure messaging: sshackford341185@direct.thedacare.org

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Greentree Health and Rehabilitation CenterClintonville, WI, CCN 525348 Skilled nursing facility Operational/Managerial Control
Managing Control - Governing Body
Adp of the SNF		 Nov 1, 2024
Nov 1, 2024
Jun 27, 2025
The Pines Post Acute and Memory CareClintonville, WI, CCN 525497 Skilled nursing facility Operational/Managerial Control
Managing Control - Governing Body
Adp of the SNF		 Nov 1, 2024
Nov 1, 2024
Nov 1, 2024

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Cloverleaf Healthcare LLC

    dba The Pines Post Acute and Memory Care

    • Skilled Nursing Facility
    • Clintonville, WI
    • NPI 1104242999

    Adp of the SNF, Managing Control - Governing Body, Operational/Managerial Control

    CMS ownership
  • Wolf River Healthcare LLC

    dba Greentree Health and Rehabilitation Center

    • Skilled Nursing Facility
    • Clintonville, WI
    • NPI 1811313604

    Adp of the SNF, Managing Control - Governing Body, Operational/Managerial Control

    CMS ownership

Organizations & group practices 10

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.

Hospital & facility affiliations 25

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

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1404086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721088000000",
    "number": "1609281567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NEENAH CTR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549563070",
            "telephone_number": "920-225-7875",
            "fax_number": "920-993-5003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 S HERITAGE WOODS DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549151408",
            "telephone_number": "920-225-7875",
            "fax_number": "920-993-5003"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "824 Illinois Ave",
            "address_purpose": "LOCATION",
            "city": "Stevens Point",
            "state": "WI",
            "postal_code": "54481",
            "country_code": "US",
            "telephone_number": "715-346-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2727 Plaza Dr",
            "address_purpose": "LOCATION",
            "city": "Wausau",
            "state": "WI",
            "postal_code": "544014192",
            "country_code": "US",
            "telephone_number": "715-847-3450",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KAMIN",
        "first_name": "SHAYNA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-30",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ME",
            "license": "TP14078",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "WI",
            "license": "69714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.