Active NPI
Shelby A Lane, PA-C
- Surgical Physician Assistant
- Fort Lauderdale, FL
National Provider Identifier
1710230651
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- PA 9106913
- Practice address
- 3319 NE 15TH CT
Fort Lauderdale, FL 33304-1709 - Phone
- (954) 257-7859
- Fax
- (954) 616-8063
- NPI assigned
- Oct 16, 2012
- Last updated
- May 7, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA 9106913 | FL | |
| Surgical Physician Assistant | 363AS0400X | PA 9106913 | FL | Primary |
Addresses
Primary practice location
3319 NE 15TH CT
Fort Lauderdale, FL 33304-1709
Mailing address
3319 NE 15TH CT
Fort Lauderdale, FL 33304-1709
Phone (954) 257-7859
Other practice location 1
3319 NE 15th Ct
Fort Lauderdale, FL 33304-1709
Phone (954) 257-7859
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G9675Z | Other | FL | MEDICARE ID-TYPE UNSPECIFIED |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
21644 State Rd
Suite 7
Boca Raton, FL 33428-1842
Phone (561) 488-8000
3319 NE 15TH CT
Fort Lauderdale, FL 33304-1709
901 45TH St
Mangonia Park, FL 33407-2413
Phone (561) 844-6300
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA 9106913 | FL | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tenet Florida Physician Services LLC | Current | Accepting new patients |
Locations
21644 State Road 7
Boca Raton, FL 33428
Phone (561) 488-8210
Interoperability endpoints
- slane2022593@direct.trinity-health.org
Organizations & group practices 4
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.
-
- Surgical Physician Assistant
- Fort Lauderdale, FL
- NPI 1780247189
-
- Orthopaedic Surgery Physician
- West Palm Beach, FL
- NPI 1912266420
-
dba Kessler Lipman Orthopedics
- Orthopaedic Surgery Physician
- Fort Lauderdale, FL
- NPI 1528034402
-
- Surgery Physician
- West Palm Beach, FL
- NPI 1659417467
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Holy Cross Medical Group
- Internal Medicine Physician
- Fort Lauderdale, FL
- NPI 1467401877
Hospital
-
dba Holy Cross Hospital
- General Acute Care Hospital
- Fort Lauderdale, FL
- NPI 1639197395
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557187200000",
"number": "1710230651",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3319 NE 15TH CT",
"city": "FORT LAUDERDALE",
"state": "FL",
"postal_code": "333041709",
"telephone_number": "954-257-7859",
"fax_number": "954-616-8063"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3319 NE 15TH CT",
"city": "FORT LAUDERDALE",
"state": "FL",
"postal_code": "333041709",
"telephone_number": "954-257-7859",
"fax_number": "954-616-8063"
}
],
"practiceLocations": [
{
"address_1": "3319 NE 15th Ct",
"address_purpose": "LOCATION",
"city": "Fort Lauderdale",
"state": "FL",
"postal_code": "333041709",
"country_code": "US",
"telephone_number": "954-257-7859",
"fax_number": "954-616-8063",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LANE",
"first_name": "SHELBY",
"middle_name": "A",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-16",
"last_updated": "2019-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "FL",
"license": "PA 9106913",
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "FL",
"license": "PA 9106913",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE ID-TYPE UNSPECIFIED",
"identifier": "G9675Z",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Lauderdale, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2019; 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.