P Michael Shattuck, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

25430 Issued in WI

Practice address

225 Memorial Dr
Berlin, WI 54923-1243

Phone

(920) 361-5538

Fax

(920) 361-5499

NPI assigned

Aug 25, 2005

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 1

Other names 1

• Paul Shattuck Other name

Medicare fee-for-service enrollment

Enrolled in WI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Thedacare Medical Center - Berlin, Inc.

  • Critical Access Hospital
  • Berlin, WI
  • NPI 1760413777

  WI

  Medicare reassignment NPD
• Thedacare, Incorporated

  • Family Medicine Physician
  • New London, WI
  • NPI 1376656959

  Family Medicine, WI

  Medicare reassignment NPD
• Ams of Wisconsin LLC

  • Methadone Clinic
  • Oshkosh, WI
  • NPI 1740651330
  NPD
• Thedacare Medical Center - Berlin, Inc.

  • Community/Retail Pharmacy
  • Berlin, WI
  • NPI 1043072291
  NPD
• Thedacare Medical Center - Berlin, Inc.

  • Anesthesiology Physician
  • Berlin, WI
  • NPI 1275943367
  NPD
• Community Medical Center of Green Lake, LLC

  • Family Medicine Physician
  • Green Lake, WI
  • NPI 1568622280

  Family Medicine

  NPD (past)
• Radiology Associates of Appleton, S.C.

  • Diagnostic Radiology Physician
  • Appleton, WI
  • NPI 1841229093
  NPD (past)
• Jeffrey G. Bentson, M.D., PLLC

  • Orthopaedic Surgery Physician
  • Port Charlotte, FL
  • NPI 1083850820
  NPD (past)

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

{
    "created_epoch": "1124928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690329600000",
    "number": "1740273630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 MEMORIAL DR",
            "city": "BERLIN",
            "state": "WI",
            "postal_code": "549231243",
            "telephone_number": "920-361-1313",
            "fax_number": "920-361-5499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 MEMORIAL DR",
            "city": "BERLIN",
            "state": "WI",
            "postal_code": "549231243",
            "telephone_number": "920-361-5538",
            "fax_number": "920-361-5499"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "N2934 Highway 22",
            "address_purpose": "LOCATION",
            "city": "Wautoma",
            "state": "WI",
            "postal_code": "549820650",
            "country_code": "US",
            "telephone_number": "920-787-4613",
            "fax_number": "920-787-5433",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHATTUCK",
        "first_name": "P",
        "middle_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-25",
        "last_updated": "2023-07-26",
        "certification_date": "2023-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "25430-020",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WI",
            "license": "25430-020",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "25430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30668600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PAUL",
            "last_name": "SHATTUCK",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Barry L Rogers, MD
• Tammi L Sawallish, OD
• Linda Louise Schink-Boers, PHYSICAL THERAPIST
• Andrew Ragnar Schoff, PHARM.D
• Amy L Schroeder, APNP
• Steven Otis Shekels
• Sonam Sheth, PT
• John W Silkey, MD
• Kerry Mark Simon, MD
• Thomas Simpkins, CRNA

• All providers in Berlin, WI
• Emergency Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.