Shane Joseph Ewalt, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

6865 Issued in AZ

Practice address

525 S Chandler Village Dr
Chandler, AZ 85226-5069

Phone

(480) 750-0303

Fax

(480) 786-5202

NPI assigned

Sep 7, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Orthopedic Specialists of North America PLLCGroup PAC ID 7719014505, 310 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Orthopedic Specialists of North America, PLLC

  • Orthopaedic Surgery Physician
  • Phoenix, AZ
  • NPI 1770812828
  Medicare reassignment Care Compare group NPD (past)
• Toca at Banner Health LLC

  • Orthopaedic Surgery Physician
  • Glendale, AZ
  • NPI 1386270932
  Medicare reassignment NPD
• Orthopedic Specialists of North America, PLLC

  • Orthopaedic Surgery Physician
  • Phoenix, AZ
  • NPI 1437569787
  NPD
• Orthopedic Specialists of North America, PLLC

  • Orthopaedic Surgery Physician
  • Gilbert, AZ
  • NPI 1962292870
  NPD

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

{
    "created_epoch": "1504742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659052800000",
    "number": "1679091920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80217",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850600217",
            "telephone_number": "602-385-2115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 S CHANDLER VILLAGE DR",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852265069",
            "telephone_number": "480-750-0303",
            "fax_number": "480-786-5202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EWALT",
        "first_name": "SHANE",
        "middle_name": "JOSEPH",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-07",
        "last_updated": "2022-07-29",
        "certification_date": "2022-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "6865",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "6865",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "326698",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Every Smile
• Evo Solutions Services LLC
• Evoke Recovery LLC
• Evoke Recovery LLC
• Evolve Health and Wellness
• Excel Social Services Inc
• Excellence in Resilience Center
• Exceptional Educational Services, LLC
• Exhale Recovery LLC
• Michele Eyanson

• Physician Assistant in Chandler, AZ
• Providers in Chandler, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.