NPIMap

Organization Active NPI

Shaw Family Medical, LLC

Doing business as Shaw Family Medical

  • Clinic/Center
  • Shaw, MS
National Provider Identifier
1750642633
Registry record updated Feb 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
SHAW FAMILY MEDICAL, LLC
Doing business as
Shaw Family Medical
Practice address
112 W Peeler Ave
Shaw, MS 38773-8710
Phone
(662) 754-3301
Fax
(662) 754-3304
NPI assigned
Jun 6, 2012
Last updated
Feb 22, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2017

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

Authorized official

Name
Nora Gough-DavisNPI 1740410661
Title
Partner
Phone
(662) 754-3301

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

112 W Peeler Ave
Shaw, MS 38773-8710

Mailing address

PO Box 299
Shaw, MS 38773-0299
Phone (662) 754-3301

Other names 1

  • Shaw Family Medical Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120809000742 MS Part B Supplier - Clinic/Group Practice 3072769843 Receives reassigned benefits from 12 practitioners
1 other NPI on this enrollment
Practice locations: Drew, MS; Shaw, MS

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Shaw Family Medical2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1338940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487721600000",
    "number": "1750642633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 299",
            "city": "SHAW",
            "state": "MS",
            "postal_code": "387730299",
            "telephone_number": "662-754-3301",
            "fax_number": "662-654-3304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 W PEELER AVE",
            "city": "SHAW",
            "state": "MS",
            "postal_code": "387738710",
            "telephone_number": "662-754-3301",
            "fax_number": "662-754-3304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAW FAMILY MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-06",
        "last_updated": "2017-02-22",
        "status": "A",
        "authorized_official_last_name": "GOUGH-DAVIS",
        "authorized_official_first_name": "NORA",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "662-754-3301"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shaw Family Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shaw, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.