Kathy Jo Shafer, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019021377 Issued in IL

Practice address

3162 Traylor TRL
Litchfield, IL 62056-4559

Phone

(217) 622-5137

NPI assigned

Aug 29, 2006

Last updated

Dec 16, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kathy.shafer.p30@direct.fhn-fqhc.nextgenshare.com
• Direct secure messaging: steven.boente.p30@direct.fhn-fqhc.nextgenshare.com

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.

• Macoupin County Public Health Department

  • Federally Qualified Health Center (FQHC)
  • Gillespie, IL
  • NPI 1538444906
  Medicare reassignment NPD
• Macoupin County Public Health Department

  dba Macoupin County Recovery Center

  • Federally Qualified Health Center (FQHC)
  • Gillespie, IL
  • NPI 1053892513
  NPD
• Macoupin County Public Health Department

  dba St Francis Way Clinic

  • Federally Qualified Health Center (FQHC)
  • Litchfield, IL
  • NPI 1720687841
  NPD
• Macoupin County Public Health Department

  • Public Health or Welfare Agency
  • Gillespie, IL
  • NPI 1447388392
  NPD (past)

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671148800000",
    "number": "1750499729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3162 TRAYLOR TRL",
            "city": "LITCHFIELD",
            "state": "IL",
            "postal_code": "620564559",
            "telephone_number": "217-622-5137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3162 TRAYLOR TRL",
            "city": "LITCHFIELD",
            "state": "IL",
            "postal_code": "620564559",
            "telephone_number": "217-622-5137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFER",
        "first_name": "KATHY",
        "middle_name": "JO",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-29",
        "last_updated": "2022-12-16",
        "certification_date": "2022-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019021377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lakshmi Sajja, DDS
• Linsey Sandoval, MD
• SC Home Health, NFP (Vono Medical Supplies Company)
• Steven Lee Schahl, DPT
• Jessie Schneider
• Larry D Shapiro, D.M.D.
• Short Furniture Co., Inc.
• Emily Sinclair
• Kari Jo Skertich, D.C.
• Theresa Ann Snyders, FNP

• General Practice Dentistry in Litchfield, IL
• Providers in Litchfield, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2022; 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.