NPIMap

Individual provider Active NPI

Richard Mark Shivers, MD

  • Family Medicine Physician
  • Salem, OH
National Provider Identifier
1639268352
Registry record updated Aug 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35-065781 Issued in OH
Practice address
564 E 2ND St
Salem, OH 44460-2914
Phone
(234) 567-8150
Fax
(234) 567-8189
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2018

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 35-065781 OH Primary

Addresses

Primary practice location

564 E 2ND St
Salem, OH 44460-2914

Mailing address

9471 Market St
Ste B
North Lima, OH 44452-8702
Phone (330) 729-2388

Other identifiers 2

IdentifierTypeStateIssuer
0975995MedicaidOH
P01712254OtherOHRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20101222000358 OH Practitioner - Family PracticePractitioner - Allergy/Immunology 0840234688 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Allergy/Immunology
Education
Northeastern Ohio University College of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

921 Orchard Bend Dr
Salem, OH 44460-1204
Phone (330) 614-8411

Hospital & facility affiliations

  • Heartland Hospice Hospice, Independence, OH, CCN 361584
  • Aultman Hospice Hospice, Canton, OH, CCN 361556
  • Alliance Community Hospital Hospital, Alliance, OH, CCN 360131
  • Aultman Hospital Hospital, Canton, OH, CCN 360084
  • Circle of Care Nursing home, Salem, OH, CCN 365977
  • Canterbury Villa of Alliance Nursing home, Alliance, OH, CCN 366214

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35-065781OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Shivers Medical Services Limited Family Medicine CurrentSince Sep 1, 2021 Accepting new patients
Salem Healthcare and Rehabilitation Center Past Accepting new patients
Miller Holdings Alliance, Inc. Past Accepting new patients
Miller Holdings Stark, Inc. Past Accepting new patients
Cardinal Mag Homes, Inc. Past Accepting new patients
Miller Holdings Stark, Inc. Past Accepting new patients
Canterbury Villa Operations Corp Past Accepting new patients

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
Circle of CareSalem, OH, CCN 365977 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Sep 1, 2021
May 13, 2025
Canterbury Villa of AllianceAlliance, OH, CCN 366214 Skilled nursing facility Adp of the SNF Feb 1, 2003

Owned or controlled facilities with NPI records 2

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

Organizations & group practices 7

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 6

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": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534291200000",
    "number": "1639268352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9471 MARKET ST",
            "address_2": "STE B",
            "city": "NORTH LIMA",
            "state": "OH",
            "postal_code": "444528702",
            "telephone_number": "330-729-2388",
            "fax_number": "330-629-6468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "564 E 2ND ST",
            "city": "SALEM",
            "state": "OH",
            "postal_code": "444602914",
            "telephone_number": "234-567-8150",
            "fax_number": "234-567-8189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIVERS",
        "first_name": "RICHARD",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2018-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35-065781",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0975995",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01712254",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OH

Sources for this page

Verify at the official NPI Registry.