NPIMap

Individual provider Active NPI

Christopher M Shubert

  • Pharmacist
  • Clive, IA
National Provider Identifier
1710310370
Registry record updated May 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
23793 Issued in IA
Practice address
15601 Hickman Rd
Clive, IA 50325-7985
Phone
(515) 987-6807
NPI assigned
Aug 18, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 20, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 121491 MN
Pharmacist 183500000X 23793 IA Primary

Addresses

Primary practice location

15601 Hickman Rd
Clive, IA 50325-7985

Mailing address

104 E Euclid Ave
Des Moines, IA 50313-4507
Phone (515) 243-0601

Other practice location 1

6975 York Ave S
Minneapolis, MN 55435-2517
Phone (952) 920-3561

Other identifiers 1

IdentifierTypeStateIssuer
1205841525OtherPHARMACY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
23793IAMDPharmacist
121491MNMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Co PastSince Jun 7, 2020 Accepting new patients
Walgreen Co Past Accepting new patients
Walgreen Co PastSince Jun 7, 2020 Accepting new patients

Organizations & group practices 3

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": "1376784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621468800000",
    "number": "1710310370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 E EUCLID AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503134507",
            "telephone_number": "515-243-0601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15601 HICKMAN RD",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503257985",
            "telephone_number": "515-987-6807"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6975 York Ave S",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554352517",
            "country_code": "US",
            "telephone_number": "952-920-3561",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHUBERT",
        "first_name": "CHRISTOPHER",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-08-18",
        "last_updated": "2021-05-20",
        "certification_date": "2021-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "121491",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IA",
            "license": "23793",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY",
            "identifier": "1205841525",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clive, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.