Kimberly Ann Shaw, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

005650 Issued in GA

Practice address

200 Cody Rd S
Le Claire, IA 52753-9579

Phone

(563) 289-2273

Fax

(563) 289-1605

NPI assigned

Jan 16, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Phoebe Physician Group, Inc

  • Clinic/Center
  • Albany, GA
  • NPI 1487899464
  NPD (past)
• Southwestern Emergency Physicians PC

  • Emergency Medicine Physician
  • Albany, GA
  • NPI 1356336986
  NPD (past)

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

{
    "created_epoch": "1137369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335139200000",
    "number": "1700865904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11532 61ST AVE",
            "city": "BLUE GRASS",
            "state": "IA",
            "postal_code": "527269660",
            "telephone_number": "563-381-5041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 CODY RD S",
            "city": "LE CLAIRE",
            "state": "IA",
            "postal_code": "527539579",
            "telephone_number": "563-289-2273",
            "fax_number": "563-289-1605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-16",
        "last_updated": "2012-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IA",
            "license": "001653",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "005650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Anne Nix, O.D.
• Warne Franklin Ramsey, MD
• Riverside Family Eye Center LLC
• Riverview Partners LLC
• Setchell Chiropractic PC
• Shepherd Chiropractic PLLC
• Ronald G Shepherd, D.C.
• Charles A Smith, DO
• Michelle M Sprengelmeyer, MD
• Spring Park Oral and Maxillofacial Surgeons, P.C.

• Physician Assistant in Le Claire, IA
• Providers in Le Claire, IA by specialty
• Physician Assistant in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2012; 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.