Active NPI
Robert Michael Shively, MD
- Family Medicine Physician
- Gardner, KS
National Provider Identifier
1750334991
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 0422740
- Practice address
- 18320 So Center St
Gardner, KS 66030 - Phone
- (913) 856-5577
- Fax
- (913) 856-3907
- NPI assigned
- May 18, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0422740 | KS | Primary |
Addresses
Primary practice location
18320 So Center St
Gardner, KS 66030
Mailing address
18320 So Center St
Gardner, KS 66030
Phone (913) 856-5577
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10038320A | Medicaid | KS |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0422740 | KS | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315440000000",
"number": "1750334991",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18320 SO CENTER ST",
"city": "GARDNER",
"state": "KS",
"postal_code": "66030",
"telephone_number": "913-856-5577",
"fax_number": "913-856-3907"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18320 SO CENTER ST",
"city": "GARDNER",
"state": "KS",
"postal_code": "66030",
"telephone_number": "913-856-5577",
"fax_number": "913-856-3907"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIVELY",
"first_name": "ROBERT",
"middle_name": "MICHAEL",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-18",
"last_updated": "2011-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "KS",
"license": "0422740",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10038320A",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gardner, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.