Individual provider Active NPI

Shamika Rouse

  • In Home Supportive Care Agency
  • Philadelphia, PA
National Provider Identifier
1669199816
Registry record updated Oct 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
License
67813601 Issued in PA
Practice address
5906 Crystal St
Philadelphia, PA 19120-1128
Phone
(267) 334-7951
NPI assigned
Oct 27, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 27, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
HomemakerGroup: 193200000X MULTI-SPECIALTY GROUP 376J00000X 67813601 PA
Respite Care 385H00000X 67813601 PA
In Home Supportive Care Agency 253Z00000X 67813601 PA Primary

Addresses

Primary practice location

5906 Crystal St
Philadelphia, PA 19120-1128

Mailing address

5906 Crystal St
Philadelphia, PA 19120-1128
Phone (267) 334-7951

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
67813601PAMDRespite Care

NPI Registry JSON

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

{
    "created_epoch": "1666828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666828800000",
    "number": "1669199816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5906 CRYSTAL ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191201128",
            "telephone_number": "267-334-7951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5906 CRYSTAL ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191201128",
            "telephone_number": "267-334-7951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUSE",
        "first_name": "SHAMIKA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-10-27",
        "last_updated": "2022-10-27",
        "certification_date": "2022-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "376J00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Homemaker",
            "state": "PA",
            "license": "67813601",
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "PA",
            "license": "67813601",
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "PA",
            "license": "67813601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2022; 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.