Kelley P Shaw

Primary specialty

Social WorkerTaxonomy code 104100000X

License

10256 Issued in SC

Practice address

10 Patewood Dr Ste 130
Greenville, SC 29615-6317

Phone

(864) 522-5550

Fax

(864) 455-4540

NPI assigned

Oct 22, 2012

Sex

Female

Sole proprietor

No

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 SC

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prisma Health University Medical GroupGroup PAC ID 8325950983, 2,467 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Prisma Health University Medical Group

  • Family Medicine Physician
  • Greenville, SC
  • NPI 1295763217
  Medicare reassignment Care Compare group NPD
• Itrust Wellness Group

  • Psychiatry Physician
  • Greenville, SC
  • NPI 1629517222
  Medicare reassignment NPD
• Itrust Wellness Group Therapeutics

  • Psychiatry Physician
  • Greenville, SC
  • NPI 1184228413
  NPD
• Prisma Health University Medical Group

  dba Parkside OB-GYN

  • Gynecology Physician
  • Greer, SC
  • NPI 1003619313
  NPD
• Itrust Cares LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Greenville, SC
  • NPI 1225751068
  NPD (past)

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

{
    "created_epoch": "1350864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686096000000",
    "number": "1750634226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-522-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 PATEWOOD DR STE 130",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296156317",
            "telephone_number": "864-522-5550",
            "fax_number": "864-455-4540"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 McGee Rd",
            "address_purpose": "LOCATION",
            "city": "Anderson",
            "state": "SC",
            "postal_code": "296252104",
            "country_code": "US",
            "telephone_number": "864-260-2220",
            "fax_number": "864-260-2225",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "117 Commons Way",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296113850",
            "country_code": "US",
            "telephone_number": "864-520-2020",
            "fax_number": "864-640-4400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAW",
        "first_name": "KELLEY",
        "middle_name": "P",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-22",
        "last_updated": "2023-06-07",
        "certification_date": "2023-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "SC",
            "license": "10256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandra Corley Shaw, PMHNP-BC
• Brandi Nicole Shaw, OTR/L
• Cynthia May Fagan Shaw
• Harold E Shaw Jr., M.D.
• Karen D Shaw, RN
• Lacey R Shaw
• Lindsay Shaw, MABC, LPCA
• Renee Shaw
• Ricki Marita Shaw, ACNP
• Hannah Lynn Shay, PMHNP-BC

• Social Worker in Greenville, SC
• Providers in Greenville, SC by specialty
• Social Worker in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.