NPIMap

Individual provider Active NPI

Melody Shaw, PA

  • Medical Physician Assistant
  • Detroit, MI
National Provider Identifier
1700905601
Registry record updated Jul 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
5601004921 Issued in MI
Practice address
3990 John R St
Detroit, MI 48201-2018
Phone
(313) 745-8040
NPI assigned
Mar 29, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 5601004921 MI Primary

Addresses

Primary practice location

3990 John R St
Detroit, MI 48201-2018

Mailing address

4967 Crooks Rd
Ste 130
Troy, MI 48098-5801
Phone (248) 952-1601

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, IN, OK3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20150706000600 MI Practitioner - Physician Assistant 9234441221 Reassigns benefits to 4 organizations
I20190214002974 IN Practitioner - Physician Assistant 9234441221 Reassigns benefits to 2 organizations
I20250325004209 OK Practitioner - Physician Assistant 9234441221 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Usacs Observation Medicine Services of Oklahoma, LLCGroup PAC ID 9931562956, 203 clinicians
Hospitalist Physicians of Indiana PCGroup PAC ID 1052795986, 148 clinicians

Practice addresses (Care Compare)

1000 W Boise Cir
Broken Arrow, OK 74012-4900
Phone (918) 994-8000

1850 State St
New Albany, IN 47150-4990
Phone (812) 944-7701

2520 E Dupont Rd
Dupont Hospital
Fort Wayne, IN 46825-1675
Phone (260) 416-3000

300 Rockefeller Dr
Muskogee, OK 74401-5075
Phone (918) 684-2101

3500 E Frank Phillips Blvd
Bartlesville, OK 74006-2411
Phone (918) 333-7200

702 Van Buren St
Fort Wayne, IN 46802-3697
Phone (260) 425-3000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601004921MIMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Paramount Medical Group PC Current Accepting new patients
In Hospitalists, LLC CurrentSince Jul 18, 2025 Accepting new patients
Pioneer Endoscopy & Surgery Center, L.L.C. CurrentSince Apr 1, 2019 Accepting new patients
St. Clair Medical Associates, P.C. Past Accepting new patients

Locations

3901 S 7th St
Terre Haute, IN 47802
Phone (812) 232-0021

27560 Hoover Rd
Warren, MI 48093
Phone (586) 573-5890

Interoperability endpoints

  • Direct secure messaging: mshaw1151041@direct.hfhs.org
  • FHIR API: https://fhir4.healow.com/fhir/r4/JDIBBA

Organizations & group practices 12

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 6

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": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438128000000",
    "number": "1700905601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4967 CROOKS RD",
            "address_2": "STE 130",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480985801",
            "telephone_number": "248-952-1601",
            "fax_number": "248-952-1614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3990 JOHN R ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012018",
            "telephone_number": "313-745-8040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "MELODY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-29",
        "last_updated": "2015-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601004921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.