Individual provider Active NPI

Caroline Rose Shea, DPT

  • Physical Therapist
  • Fairbanks, AK
National Provider Identifier
1689345167
Registry record updated Jul 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
187471 Issued in AK
Practice address
530 7TH Ave Ste 1
Fairbanks, AK 99701-4971
Phone
(907) 415-4222
Fax
(907) 206-7156
NPI assigned
Sep 23, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 13125 TN
Physical Therapist 225100000X 187471 AK Primary

Addresses

Primary practice location

530 7TH Ave Ste 1
Fairbanks, AK 99701-4971

Mailing address

530 7TH Ave Ste 1
Fairbanks, AK 99701-4971
Phone (907) 415-4222

Other practice location 1

1314 Peabody Ave
Memphis, TN 38104-3500
Phone (901) 321-5803

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220331002167 AK Practitioner - Physical Therapist in Private Practice 6406242379 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

530 7TH Ave
Suite 1
Fairbanks, AK 99701-4971
Phone (907) 415-4222

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13125TNMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Physical Therapy Inc Physical Therapist CurrentSince Mar 4, 2022 Accepting new patients
Inner Strength, LLC Physical Therapist CurrentSince Jul 9, 2024 Accepting new patients

Locations

1917 Abbott Rd
Ste 200
Anchorage, AK 99507
Phone (907) 279-4266

1275 Sadler Way
Ste 201
Fairbanks, AK 99701
Phone (907) 374-0992

530 7th Ave
Ste 1
Fairbanks, AK 99701
Phone (907) 415-4222

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1632355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721692800000",
    "number": "1689345167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 7TH AVE STE 1",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014971",
            "telephone_number": "907-415-4222",
            "fax_number": "907-206-7156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 7TH AVE STE 1",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014971",
            "telephone_number": "907-415-4222",
            "fax_number": "907-206-7156"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1314 Peabody Ave",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381043500",
            "country_code": "US",
            "telephone_number": "901-321-5803",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHEA",
        "first_name": "CAROLINE",
        "middle_name": "ROSE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-23",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "13125",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AK",
            "license": "187471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.