Individual provider Active NPI

Dennis Norbert Shelle, MD

  • Pediatrics Physician
  • Tecumseh, MI
National Provider Identifier
1740244789
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
4301047781 Issued in MI
Practice address
6869 S Occidental Rd
Tecumseh, MI 49286-9784
Phone
(517) 423-4777
Fax
(517) 423-7257
NPI assigned
Apr 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X DS047781 MI
Internal Medicine Physician 207R00000X DS047781 MI
Pediatrics Physician 208000000X 4301047781 MI Primary

Addresses

Primary practice location

6869 S Occidental Rd
Tecumseh, MI 49286-9784

Mailing address

1 Seagate Ste 800
Toledo, OH 43604-1558
Phone (517) 423-4777

Other identifiers 2

IdentifierTypeStateIssuer
1740244789MedicaidMI
2768873MedicaidMI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dshelle30553@epicdirect.promedica.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080429000365 MI Practitioner - Internal MedicinePractitioner - Pediatric Medicine 7113913716 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Wayne State University School of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

200 E Russell Rd
Unit C
Tecumseh, MI 49286-2072
Phone (517) 263-9491

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DS047781MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Central Corporation of Michigan Internal Medicine CurrentSince Dec 1, 2018 Accepting new patients

Locations

501 E Cummins St
Tecumseh, MI 49286
Phone (517) 423-2960

200 E Russell Rd
Unit C
Tecumseh, MI 49286
Phone (517) 424-3883

100 Madison Ave
Toledo, OH 43604
Phone (567) 585-1964

1 Seagate
Ste 800
Toledo, OH 43604

Interoperability endpoints

  • Direct secure messaging: dshelle30553@direct.promedica.org

Organizations & group practices 1

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": "1144972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1740244789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SEAGATE STE 800",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436041558",
            "telephone_number": "517-423-4777",
            "fax_number": "517-423-7257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6869 S OCCIDENTAL RD",
            "city": "TECUMSEH",
            "state": "MI",
            "postal_code": "492869784",
            "telephone_number": "517-423-4777",
            "fax_number": "517-423-7257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHELLE",
        "first_name": "DENNIS",
        "middle_name": "NORBERT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-14",
        "last_updated": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MI",
            "license": "DS047781",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "DS047781",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301047781",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1740244789",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2768873",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dshelle30553@epicdirect.promedica.org",
            "affiliation": "N",
            "address_1": "100 Madison Ave",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436041516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tecumseh, MI

Sources for this page

Verify at the official NPI Registry.