NPIMap

Organization Active NPI

Shea Clinic

  • Ambulatory Surgical Clinic/Center
  • Memphis, TN
National Provider Identifier
1760447015
Registry record updated Oct 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
0000000050 Issued in TN
Legal business name
SHEA CLINIC
Doing business as
Shea Clinic, ASC
Practice address
6133 Poplar Pike
Memphis, TN 38119-4707
Phone
(901) 761-9720
Fax
(901) 683-8440
NPI assigned
Apr 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2010

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

Authorized official

Name
Mr. John R Gross
Title
Administrator
Phone
(901) 761-9720

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 0000000050 TN Primary

Addresses

Primary practice location

6133 Poplar Pike
Memphis, TN 38119-4707

Mailing address

PO Box 17987
Memphis, TN 38187-0987
Phone (901) 761-9720

Other identifiers 1

IdentifierTypeStateIssuer
490000678OtherTNRAILROAD MEDICARE

Other names 1

  • Shea Clinic, ASC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141124001706 TN Part B Supplier - Ambulatory Surgical Center 3971525635 Practice locations: Memphis, TN

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Shea Clinic Dba Shea Clinic ASCCCN 44C0001012
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Shea Clinic2 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.

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287619200000",
    "number": "1760447015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17987",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381870987",
            "telephone_number": "901-761-9720",
            "fax_number": "901-683-8440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6133 POPLAR PIKE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381194707",
            "telephone_number": "901-761-9720",
            "fax_number": "901-683-8440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHEA CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-19",
        "last_updated": "2010-10-21",
        "status": "A",
        "authorized_official_last_name": "GROSS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "901-761-9720",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TN",
            "license": "0000000050",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "490000678",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shea Clinic, ASC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.