NPIMap

Individual provider Active NPI

Carol L Shackleton, M.D.

  • Family Medicine Physician
  • Gothenburg, NE
National Provider Identifier
1629004759
Registry record updated Feb 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
16620 Issued in NE
Practice address
918 20TH Street
Gothenburg, NE 69138-1237
Phone
(308) 537-7131
Fax
(308) 537-7310
NPI assigned
Jun 23, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 9, 2012

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 16620 NE Primary

Addresses

Primary practice location

918 20TH Street
Gothenburg, NE 69138-1237

Mailing address

918 20TH Street
Gothenburg, NE 69138-1237
Phone (308) 537-7131

Other identifiers 5

IdentifierTypeStateIssuer
6366OtherNEMIDLANDS CHOICE
100253852-00MedicaidNE
11595205OtherNECAQH
03042OtherNESTATE BC/BS
099905OtherNEMEDICARE GROUP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ainsworth Family Clinic, P.C. Family Medicine Past Accepting new patients
Craig D Bartruff M.D., P.C. Past Accepting new patients
David Hult, M.D., P.C. Family Medicine Past Accepting new patients
Family and Sport Medicine, PC Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328745600000",
    "number": "1629004759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "918 20TH STREET",
            "city": "GOTHENBURG",
            "state": "NE",
            "postal_code": "691381237",
            "telephone_number": "308-537-7131",
            "fax_number": "308-537-7310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "918 20TH STREET",
            "city": "GOTHENBURG",
            "state": "NE",
            "postal_code": "691381237",
            "telephone_number": "308-537-7131",
            "fax_number": "308-537-7310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKLETON",
        "first_name": "CAROL",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-23",
        "last_updated": "2012-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "16620",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDLANDS CHOICE",
            "identifier": "6366",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100253852-00",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11595205",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE BC/BS",
            "identifier": "03042",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "099905",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gothenburg, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.