Individual provider Active NPI

Jeremiah J Shaw, MD

  • Family Medicine Physician
  • Monona, WI
National Provider Identifier
1619439403
Registry record updated Dec 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
74863-20 Issued in WI
Practice address
1050 E Broadway
Monona, WI 53716-4023
Phone
(608) 287-5899
Fax
(608) 251-2332
NPI assigned
Apr 2, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 74863-20 WI Primary

Addresses

Primary practice location

1050 E Broadway
Monona, WI 53716-4023

Mailing address

7974 Uw Health CT
Middleton, WI 53562-5531

Other practice location 1

1102 S Park St
Madison, WI 53715-1708
Phone (608) 263-3111

Other practice location 2

621 Science Dr
Madison, WI 53711-1074
Phone (608) 262-9355

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jshaw1046192@direct.uwhealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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

Enrollment IDStateProvider typePAC IDDetails
I20220817003374 WI Practitioner - Family Practice 3375877558 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Ohio State University College of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Wisconsin Medical Foundation IncGroup PAC ID 6608785464, 2,537 clinicians

Practice addresses (Care Compare)

1050 Division St
Mauston, WI 53948-1931
Phone (608) 847-6161

Hospital & facility affiliations

  • University of Wi Hospitals & Clinics Authority Hospital, Madison, WI, CCN 520098

Merit-based Incentive Payment System (MIPS)

Final score
83.32 of 100Reported as group
Quality
87.78
Promoting interoperability
77
Improvement activities
40
Cost
75.8

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Wisconsin Medical Foundation, Inc CurrentSince Sep 1, 2022 Accepting new patients
University of Wisconsin Medical Foundation, Inc CurrentSince Sep 1, 2022 Accepting new patients
University of Wisconsin Medical Foundation Inc Past Accepting new patients

Locations

600 Highland Ave
Madison, WI 53792
Phone (608) 263-0325

1100 Delaplaine Ct
Madison, WI 53715
Phone (608) 241-9020

2402 Winnebago St
Madison, WI 53704
Phone (608) 242-6840

1102 S Park St
Madison, WI 53715
Phone (608) 263-3111

7102 Mineral Point Rd
Madison, WI 53717
Phone (608) 828-7603

621 Science Dr
Madison, WI 53711
Phone (608) 263-8850

1050 Division St
Mauston, WI 53948
Phone (608) 847-6161

7974 Uw Health Ct
Middleton, WI 53562
Phone (608) 829-5270

1050 E Broadway
Monona, WI 53716
Phone (608) 222-8779

Interoperability endpoints

  • Direct secure messaging: jshaw312466@direct-ehr-ssmhc.com

Organizations & group practices 3

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 1

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": "1554163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733356800000",
    "number": "1619439403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7974 UW HEALTH CT",
            "city": "MIDDLETON",
            "state": "WI",
            "postal_code": "535625531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 E BROADWAY",
            "city": "MONONA",
            "state": "WI",
            "postal_code": "537164023",
            "telephone_number": "608-287-5899",
            "fax_number": "608-251-2332"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1102 S Park St",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "WI",
            "postal_code": "537151708",
            "country_code": "US",
            "telephone_number": "608-263-3111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "621 Science Dr",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "WI",
            "postal_code": "537111074",
            "country_code": "US",
            "telephone_number": "608-262-9355",
            "fax_number": "608-263-2215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAW",
        "first_name": "JEREMIAH",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-02",
        "last_updated": "2024-12-05",
        "certification_date": "2024-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "74863-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jshaw1046192@direct.uwhealth.org",
            "affiliation": "N",
            "address_1": "2402 Winnebago St",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537045341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Monona, WI

Sources for this page

Verify at the official NPI Registry.