Eugene A. Shooter, Jr., PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

00810002612 Issued in VA

Practice address

5276 Dawes Ave
Alexandria, VA 22311-1404

Phone

(703) 379-7350

Fax

(703) 379-7352

NPI assigned

Jun 20, 2006

Last updated

Mar 6, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 12

Other names 1

• Gene Shooter, Jr. Other name

Medicare fee-for-service enrollment

Enrolled in DC

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Texas Tech University Health Science Center School of Medicine, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Potomac Center IncGroup PAC ID 2860484094, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Potomac Center Inc

  • Professional Counselor
  • Alexandria, VA
  • NPI 1457403099

  Clinical, DC

  Medicare reassignment Care Compare group NPD
• T Med Behavioral Inc

  • Clinical Psychologist
  • Fairfax, VA
  • NPI 1497719272
  NPD (past)

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204761600000",
    "number": "1720024821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5276 DAWES AVE",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223111404",
            "telephone_number": "703-379-7350",
            "fax_number": "703-379-7352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5276 DAWES AVE",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223111404",
            "telephone_number": "703-379-7350",
            "fax_number": "703-379-7352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOOTER, JR.",
        "first_name": "EUGENE",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-20",
        "last_updated": "2008-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "00810002612",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "DC",
            "license": "PSY1878",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "HI",
            "license": "PSY518",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PCI APS",
            "identifier": "110936",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PCI VALUE OPTIONS",
            "identifier": "158367",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "2122539",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PCI KAISER PERMANENTE",
            "identifier": "228758",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PCI ANTHEM",
            "identifier": "453769",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PCI AETNA",
            "identifier": "2787110",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM HEALTHKEEPERS",
            "identifier": "142975",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "T-MED BC/BS VA",
            "identifier": "142975",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PCI TRICARE",
            "identifier": "158367",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BC/BS",
            "identifier": "48900016",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHCS",
            "identifier": "9123953",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS DC",
            "identifier": "G3960017",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GENE",
            "last_name": "SHOOTER, JR.",
            "credential": "PH.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Lindsay Shmatov, FNP
• Rokhsareh Sarah Shoaee
• Shobha Chidambaram, MD, PC
• Leah Shoemaker, PT
• Jeannette Cazares Shooshtari
• Erika Shor, CRNA
• Sarah Kathleen Shores
• Jennifer Shotlander, LCSW
• Shuaib Medical Center
• Ryan S. Shugarman, M.D.

• Clinical Psychologist in Alexandria, VA
• Providers in Alexandria, VA by specialty
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2008; 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.