NPIMap

Individual provider Active NPI

Brett Michael Shaffer, M.D.

  • Emergency Medicine Physician
  • Chehalis, WA
National Provider Identifier
1619187523
Registry record updated Apr 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
11754 Issued in SD
Practice address
1299 Bishop Rd
Chehalis, WA 98532-8758
Phone
(360) 740-4001
NPI assigned
May 23, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 27, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD.MD.60196368 WA
Emergency Medicine Physician 207P00000X 11754 SD Primary

Addresses

Primary practice location

1299 Bishop Rd
Chehalis, WA 98532-8758

Mailing address

3526 Becket St NE
Lacey, WA 98516-6291
Phone (240) 418-1515

Other practice location 1

353 Fairmont Blvd
Rapid City, SD 57701-7375
Phone (605) 755-8222

Other names 1

  • Dr. Brett Michael Shaffer Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD, IL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200501002665 SD Practitioner - Emergency Medicine 2668644253 Reassigns benefits to 3 organizations
I20230413002355 IL Practitioner - Emergency Medicine 2668644253 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Monument Health Network IncGroup PAC ID 5991616427, shared by 12 NPIs, 163 clinicians

Practice addresses (Care Compare)

1220 Montgomery St
Custer, SD 57730-1705
Phone (605) 673-4150

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11754SDMDEmergency Medicine Physician
MD.MD.60196368WAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Osf Multi-Specialty Group CurrentSince Apr 3, 2023 Accepting new patients
Monument Health Network, Inc. Emergency Medicine CurrentSince Dec 30, 2023 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Cepamerica Illinois LLP Emergency Medicine CurrentSince Apr 1, 2024 Accepting new patients
Fall River Health Services CurrentSince Dec 1, 2025 Accepting new patients
Monument Health Network, Inc CurrentSince Oct 17, 2024 Accepting new patients
Cepamerica Illinois LLP Emergency Medicine CurrentSince Apr 1, 2024 Accepting new patients
Monument Health Network, Inc. Current Accepting new patients
Fall River Health Services CurrentSince Dec 1, 2025 Accepting new patients
Cepamerica Illinois LLP Emergency Medicine Current Accepting new patients
Rapid City Emergency Services PA Emergency Medicine CurrentSince Apr 20, 2020 Accepting new patients
Thurston Emergency Group a Professional LLC Emergency Medicine Past Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

3249 Oak Park Ave
Berwyn, IL 60402
Phone (708) 783-2696

2200 E Washington St
Bloomington, IL 61701
Phone (309) 662-3311

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

200 S Cedar St
Shelbyville, IL 62565
Phone (217) 774-3961

1220 Montgomery St
Custer, SD 57730
Phone (605) 673-4150

1201 Highway 71 S
Hot Springs, SD 57747
Phone (605) 745-3159

353 Fairmont Blvd
Rapid City, SD 57701
Phone (605) 719-1000

1440 N Main St
Spearfish, SD 57783
Phone (605) 644-4000

Organizations & group practices 12

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587945600000",
    "number": "1619187523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3526 BECKET ST NE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985166291",
            "telephone_number": "240-418-1515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1299 BISHOP RD",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985328758",
            "telephone_number": "360-740-4001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "353 Fairmont Blvd",
            "address_purpose": "LOCATION",
            "city": "Rapid City",
            "state": "SD",
            "postal_code": "577017375",
            "country_code": "US",
            "telephone_number": "605-755-8222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAFFER",
        "first_name": "BRETT",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-23",
        "last_updated": "2020-04-27",
        "certification_date": "2020-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "MD.MD.60196368",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SD",
            "license": "11754",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRETT",
            "last_name": "SHAFFER",
            "middle_name": "MICHAEL",
            "prefix": "DR.",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Chehalis, WA

Sources for this page

Verify at the official NPI Registry.