Individual provider Active NPI

Alexandra Shaw, MD

  • Neurology with Special Qualifications in Child Neurology Physician
  • Royal Oak, MI
National Provider Identifier
1689808297
Registry record updated Oct 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
License
4301111625 Issued in MI
Practice address
3555 W 13 Mile Rd Ste N120
Royal Oak, MI 48073-6710
Phone
(855) 863-8761
Fax
(248) 551-8190
NPI assigned
May 11, 2009
Last updated
Oct 22, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

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
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X 4301111625 MI Primary

Addresses

Primary practice location

3555 W 13 Mile Rd Ste N120
Royal Oak, MI 48073-6710

Mailing address

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

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ashaw475506@direct.beaumont.edu

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20170523000727 MI Practitioner - Pediatric Medicine 1153698147 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301111625MIMDNeurology with Special Qualifications in Child Neurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Oakwood Ambulatory LLC CurrentSince Oct 15, 2017 Accepting new patients
Oakwood Ambulatory, LLC CurrentSince Oct 15, 2017 Accepting new patients
William Beaumont Hospital Current Accepting new patients
Beaumont Medical Group- Specialty Services CurrentSince Mar 24, 2018 Accepting new patients
William Beaumont Hospital CurrentSince Jun 1, 2017 Accepting new patients
William Beaumont Hospital CurrentSince Jun 1, 2017 Accepting new patients
Oakwood Healthcare Inc Past Accepting new patients
William Beaumont Hospital Past Accepting new patients
William Beaumont Hospital Past Accepting new patients

Locations

201 3rd St
Ste 200
Belleville, MI 48111
Phone (734) 697-9065

18100 Oakwood Blvd
Ste 303
Dearborn, MI 48124
Phone (313) 438-5998

28100 Grand River Ave
Ste 301
Farmington Hills, MI 48336
Phone (947) 521-1320

3535 W 13 Mile Rd
Ste N120
Royal Oak, MI 48073
Phone (855) 863-8761

3555 W 13 Mile Rd
Ste N120
Royal Oak, MI 48073
Phone (248) 551-1550

26001 Jefferson Ave
Saint Clair Shores, MI 48081
Phone (586) 779-7000

26901 Beaumont Blvd
Ste 3D
Southfield, MI 48033
Phone (947) 522-1860

130 Town Center Dr
Ste 203
Troy, MI 48084
Phone (248) 585-8250

44199 Dequindre Rd
Ste 103
Troy, MI 48085
Phone (248) 964-9220

Interoperability endpoints

  • Direct secure messaging: ashaw1255562@epic00.shdirect.org
  • Direct secure messaging: ashaw475506@direct.beaumont.edu

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1242000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603324800000",
    "number": "1689808297",
    "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": "3555 W 13 MILE RD STE N120",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736710",
            "telephone_number": "855-863-8761",
            "fax_number": "248-551-8190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "ALEXANDRA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-11",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "MI",
            "license": "4301111625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ashaw475506@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "3555 W 13 Mile Rd Ste N120",
            "city": "Royal Oak",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480736710",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Royal Oak, MI

Sources for this page

Verify at the official NPI Registry.