NPIMap

Individual provider Active NPI

Charles T Shaw, M.D.

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1720086960
Registry record updated Mar 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036078790 Issued in IL
Practice address
6084 S Archer Ave
Chicago, IL 60638-2747
Phone
(773) 355-2800
NPI assigned
Jul 12, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036078790 IL Primary

Addresses

Primary practice location

6084 S Archer Ave
Chicago, IL 60638-2747

Mailing address

6084 S Archer Ave
Chicago, IL 60638-2747
Phone (773) 355-2800

Other identifiers 1

IdentifierTypeStateIssuer
036078790MedicaidIL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040329000310 IL Practitioner - Internal Medicine 1254222425 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Indiana University School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Adventist Health Partners, Inc.Group PAC ID 0244135762, 253 clinicians

Practice addresses (Care Compare)

396 Remington Blvd
Bolingbrook, IL 60440-4311

6084 S Archer Ave
Chicago, IL 60638-2747
Phone (773) 229-8508

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health Partners, Inc. Current Accepting new patients
Adventist Health Partners,Inc CurrentSince Apr 1, 2024 Accepting new patients
Adventist Health Partners, Inc. CurrentSince Apr 1, 2024 Accepting new patients
Adventist Health Partners,Inc Past Accepting new patients

Locations

396 Remington Blvd
Ste 231
Bolingbrook, IL 60440
Phone (630) 312-4301

6084 S Archer Ave
Chicago, IL 60638
Phone (708) 442-0221

Interoperability endpoints

  • Direct secure messaging: cshaw2770874@adventhealth.direct-ci.com

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 and National Provider Directory roles.

Hospital & facility affiliations 9

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": "1121126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709510400000",
    "number": "1720086960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6084 S ARCHER AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606382747",
            "telephone_number": "773-355-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6084 S ARCHER AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606382747",
            "telephone_number": "773-355-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "CHARLES",
        "middle_name": "T",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-12",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036078790",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036078790",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.