NPIMap

Individual provider Active NPI

Charles J Shanley, MD

  • Vascular Surgery Physician
  • Grosse Pointe, MI
National Provider Identifier
1689614141
Registry record updated Oct 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
4301051382 Issued in MI
Practice address
16815 E Jefferson Ave Ste 240
Grosse Pointe, MI 48230-1923
Phone
(313) 473-4690
Fax
(248) 551-3023
NPI assigned
Jun 6, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 22, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 4301051382 MI Primary

Addresses

Primary practice location

16815 E Jefferson Ave Ste 240
Grosse Pointe, MI 48230-1923

Mailing address

26901 Beaumont Blvd Ste 3D
Southfield, MI 48033-3849

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cshanley11051@direct.beaumont.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041021000762 MI Practitioner - Vascular Surgery 6901867050 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
Wayne State University School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Vascular and Endovascular Associates PLC 6 clinicians

Practice addresses (Care Compare)

525 E Big Beaver Rd
Suite 125
Troy, MI 48083-1367
Phone 24868898606

Hospital & facility affiliations

  • Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130
  • Beaumont Hospital - Grosse Pointe Hospital, Grosse Pointe, MI, CCN 230089
  • Beaumont Hospital, Troy Hospital, Troy, MI, CCN 230269
  • Beaumont Hospital - Farmington Hills Hospital, Farmington Hills, MI, CCN 230151

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
98.14
Promoting interoperability
100
Improvement activities
40
Cost
83.11

Merit-based Incentive Payment System (MIPS)

Final score
84.37 of 100Reported as group
Quality
66.73
Promoting interoperability
100
Improvement activities
40
Cost
70.98

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)21
Removal of tissue14

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Vascular and Endovascular Institute of Michigan PC Vascular Surgery CurrentSince Aug 15, 2023 Accepting new patients
Vascular & Endovascular Associates PLC Vascular Surgery CurrentSince Apr 15, 2025 Accepting new patients
Michigan Multispecialty Physicians, P.C. Vascular Surgery Past Accepting new patients
Noninvasive Vascular Testing Inc Vascular Surgery Past Accepting new patients

Locations

42855 Garfield Rd
Ste 112
Clinton Township, MI 48038
Phone (586) 228-3180

468 Cadieux Rd
Grosse Pt Wds, MI 48230
Phone (313) 343-1000

3601 W 13 Mile Rd
Royal Oak, MI 48073

3601 W 13 Mile Rd
#102
Royal Oak, MI 48073

44201 Dequindre Rd
Troy, MI 48085
Phone (248) 471-8255

525 E Big Beaver Rd
Ste 125
Troy, MI 48083
Phone (248) 688-9860

Interoperability endpoints

  • Direct secure messaging: cshanley882160@direct.hfhs.org
  • Direct secure messaging: cshanley11051@direct.beaumont.edu

Organizations & group practices 5

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.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603324800000",
    "number": "1689614141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD STE 3D",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16815 E JEFFERSON AVE STE 240",
            "city": "GROSSE POINTE",
            "state": "MI",
            "postal_code": "482301923",
            "telephone_number": "313-473-4690",
            "fax_number": "248-551-3023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANLEY",
        "first_name": "CHARLES",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MI",
            "license": "4301051382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cshanley11051@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "16815 E Jefferson Ave Ste 240",
            "city": "Grosse Pointe",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482301923",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grosse Pointe, MI

Sources for this page

Verify at the official NPI Registry.