NPIMap

Individual provider Active NPI

Shawn Kathleen Ross, MD

  • Family Medicine Physician
  • Lakeside Park, KY
National Provider Identifier
1659477180
Registry record updated Oct 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25375 Issued in KY
Practice address
2300 Chamber Center Dr
Lakeside Park, KY 41017-1686
Phone
(859) 341-3114
Fax
(859) 578-2156
NPI assigned
Sep 15, 2006
Last updated
Oct 18, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2022

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 25375 KY Primary

Addresses

Primary practice location

2300 Chamber Center Dr
Lakeside Park, KY 41017-1686

Mailing address

PO Box 635283
Cincinnati, OH 45263-5283
Phone (859) 344-5555

Other identifiers 2

IdentifierTypeStateIssuer
000000052213OtherKYANTHEM
64253750MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20100424000006 KY Practitioner - Family Practice 2961539820 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Summit Medical Group IncGroup PAC ID 2163326240, 803 clinicians

Practice addresses (Care Compare)

2300 Chamber Ctr Dr
Suite 100
Lakeside Park, KY 41017-1686
Phone (859) 341-3114

580 Buttermilk Pike
Crescent Springs, KY 41017-1635
Phone (859) 341-6654

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3362KYMDClinical Social Worker
25375KYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group, Inc. CurrentSince Oct 17, 2022 Accepting new patients
Summit Medical Group, Inc Family Medicine CurrentSince Oct 17, 2022 Accepting new patients
Summit Medical Group, Inc Family Medicine Current Accepting new patients
Medcorps Asthma and Pulmonary Specialists LLC Past Accepting new patients
PMR Ky Holding, LLC PastSince Feb 1, 2022 Accepting new patients

Locations

405 Violet Rd
Crittenden, KY 41030
Phone (859) 428-1610

1980 Litton Ln
Hebron, KY 41048
Phone (859) 334-8700

2300 Chamber Center Dr
Lakeside Park, KY 41017
Phone (859) 341-3114

2300 Chamber Center Dr
Ste 100
Lakeside Park, KY 41017
Phone (859) 331-2440

1400 Grand Ave
Newport, KY 41071
Phone (859) 905-3070

300 Barnes Rd
Williamstown, KY 41097
Phone (859) 824-8217

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/11515/brand/1/csg/1/fhir/r4
  • Direct secure messaging: sross388515@direct-prd.stelizabeth.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666051200000",
    "number": "1659477180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 635283",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452635283",
            "telephone_number": "859-344-5555",
            "fax_number": "859-344-5552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 CHAMBER CENTER DR",
            "city": "LAKESIDE PARK",
            "state": "KY",
            "postal_code": "410171686",
            "telephone_number": "859-341-3114",
            "fax_number": "859-578-2156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSS",
        "first_name": "SHAWN",
        "middle_name": "KATHLEEN",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-15",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "25375",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000052213",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64253750",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeside Park, KY

Sources for this page

Verify at the official NPI Registry.