Brenda J Shaw, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA587 Issued in ID

Practice address

1660 John Adams Pkwy
Idaho Falls, ID 83401-4360

Phone

(208) 523-8844

Fax

(208) 529-8684

NPI assigned

Nov 7, 2006

Sex

Female

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 ID

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Idaho Arthritis & Osteoporosis Center PC

  dba Idaho Arthritis Center

  • Legal Medicine
  • Meridian, ID
  • NPI 1770539298
  Medicare reassignment
• Eric a. Wingerson, D.O. & Digestive Health Center, PC

  • Gastroenterology Physician
  • Idaho Falls, ID
  • NPI 1780766071
  NPD (past)
• Life Spring Womens Clinic, P.a.

  • Obstetrics & Gynecology Physician
  • Idaho Falls, ID
  • NPI 1992840326
  NPD (past)

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260835200000",
    "number": "1679642037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1660 JOHN ADAMS PKWY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834014360",
            "telephone_number": "208-523-8844",
            "fax_number": "208-529-8684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1660 JOHN ADAMS PKWY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834014360",
            "telephone_number": "208-523-8844",
            "fax_number": "208-529-8684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "BRENDA",
        "middle_name": "J",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-07",
        "last_updated": "2009-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807324700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lindsay D. Sewell, M.D.
• Amir M Shama, O.D.
• Elizabeth Ann Sharp-Marsden, APRN-CNP
• Michael Meek Sharp, DMD
• Alison Shaw, BS
• Dimitri Shchadenko, FNP
• Sean Richard Shearen, MD
• Derrick Shedd
• Haley Joann Sheffield Evans, DNP, FNP, RN
• Alexis Shelton

• Physician Assistant in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2009; 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.