Individual provider Active NPI

Shanelle Raugh, DO

  • Family Medicine Physician
  • Jamaica, NY
National Provider Identifier
1649808726
Registry record updated Jun 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
329774 Issued in NY
Practice address
8268 164TH St
Jamaica, NY 11432-1104
Phone
(718) 883-4847
NPI assigned
Apr 1, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 329774 NY
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 329774 NY Primary

Addresses

Primary practice location

8268 164TH St
Jamaica, NY 11432-1104

Mailing address

8268 164TH St
Jamaica, NY 11432-1104
Phone (716) 597-8817

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20240516001849 NY Practitioner - Family Practice 4486095882 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Apogee Medical Group, New York, PCGroup PAC ID 4587793294, 117 clinicians

Practice addresses (Care Compare)

462 Grider St
Buffalo, NY 14215-3021
Phone (716) 898-3000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
329774NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Apogee Medical Group, New York, PC Internal Medicine CurrentSince May 8, 2024 Accepting new patients
Erie County Medical Center Corporation Past Accepting new patients

Locations

462 Grider St
Cheektowaga, NY 14215
Phone (716) 831-8612

515 Main St
Olean, NY 14760
Phone (716) 373-2600

Organizations & group practices 2

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": "1585699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718064000000",
    "number": "1649808726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8268 164TH ST",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114321104",
            "telephone_number": "716-597-8817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8268 164TH ST",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114321104",
            "telephone_number": "718-883-4847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAUGH",
        "first_name": "SHANELLE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-01",
        "last_updated": "2024-06-11",
        "certification_date": "2024-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "329774",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "329774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamaica, NY

Sources for this page

Verify at the official NPI Registry.