Gretchen Lynne Shull, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

50.007682 Issued in OH

Practice address

7676 Reynolds Rd
Mentor, OH 44060-5110

Phone

(440) 283-3015

Fax

(440) 283-3010

NPI assigned

Aug 9, 2017

Last updated

Jan 31, 2024By the provider in NPPES

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

Other names 1

• Gretchen Miller Former name

Medicare fee-for-service enrollment

Enrolled in PA, OH2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Optima Dermatology LLCGroup PAC ID 3971561648, 74 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gshull@optima.emadirect.md
• Direct secure messaging: gshull423783@ehrdirect.uhhospitals.org

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.

• Optima Dermatology LLC

  • Dermatology Physician
  • Boardman, OH
  • NPI 1831187764
  Medicare reassignment Care Compare group
• Butler Medical Providers

  • Gastroenterology Physician
  • Butler, PA
  • NPI 1619493046
  Medicare reassignment
• Butler Medical Providers

  • Endocrinology, Diabetes & Metabolism Physician
  • Butler, PA
  • NPI 1023478237
  NPD
• Butler Medical Providers

  • Rural Health Clinic/Center
  • Fairmount City, PA
  • NPI 1386253854
  NPD
• Advanced Dermatology and Skin Cancer Center

  • Clinical Medical Laboratory
  • Boardman, OH
  • NPI 1497912893
  NPD (past)

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

{
    "created_epoch": "1502236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706659200000",
    "number": "1699290783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 NEW HAMPSHIRE AVE STE 2",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038012864",
            "telephone_number": "802-909-2053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7676 REYNOLDS RD",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440605110",
            "telephone_number": "440-283-3015",
            "fax_number": "440-283-3010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHULL",
        "first_name": "GRETCHEN",
        "middle_name": "LYNNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-09",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.007682",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103368190",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GRETCHEN",
            "last_name": "MILLER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bonnie Kellogg Shinhearl, PC
• Brandon Shinhearl
• Matthew Joseph Short, PT
• Wanda Shoulders
• Trina Showers
• Rob Shulman, R.PH.
• Deanna Shumate, RN
• Sondra Akins Siatkowski, AGNP-C
• Heather Sibley, LSW
• Virginia Sidlo, LISW

• Physician Assistant in Mentor, OH
• Providers in Mentor, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; 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.
• 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.