John A Shutta, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

D0030020 Issued in MD

Practice address

15 E Frederick St
Walkersville, MD 21793-8234

Phone

(301) 898-5200

Fax

(301) 898-5230

NPI assigned

Jun 15, 2005

Last updated

May 20, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MD

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Frederick Health Medical Group LLC

  dba Frederick Health Medical Group

  • Family Medicine Physician
  • Frederick, MD
  • NPI 1619258225
  Medicare reassignment NPD
• John a Shutta, MD, PA

  dba Glade Valley Family Practice

  • Family Medicine Physician
  • Walkersville, MD
  • NPI 1114923729
  Authorized official Same address or phone
• Frederick Health Medical Group LLC

  dba Monocacy Health Partners Dental Clinic

  • General Practice Dentistry
  • Frederick, MD
  • NPI 1073973012
  NPD
• Frederick Health Medical Group LLC

  • Family Medicine Physician
  • Mount Airy, MD
  • NPI 1114771862
  NPD
• Frederick Health Hospital Inc

  dba Frederick Health Hospital

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

{
    "created_epoch": "1118793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589932800000",
    "number": "1679578983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 37086",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212973086",
            "telephone_number": "240-439-8812",
            "fax_number": "301-898-5230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 E FREDERICK ST",
            "city": "WALKERSVILLE",
            "state": "MD",
            "postal_code": "217938234",
            "telephone_number": "301-898-5200",
            "fax_number": "301-898-5230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUTTA",
        "first_name": "JOHN",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-15",
        "last_updated": "2020-05-20",
        "certification_date": "2020-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D0030020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "378781800",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Craig Stachewicz, P.A.
• Patricia Kay Stafford, CRNP

• Family Medicine Physician in Walkersville, MD
• Providers in Walkersville, MD by specialty
• Family Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.