Active NPI
Suzanne L Shaw, MD
- Diagnostic Radiology Physician
- Great Falls, MT
National Provider Identifier
1770577942
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 7782
- Practice address
- 3000 15TH Ave South
Great Falls, MT 59405 - Phone
- (406) 454-2171
- Fax
- (406) 771-3021
- NPI assigned
- Sep 2, 2005
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 7782 | MT | Primary |
Addresses
Primary practice location
3000 15TH Ave South
Great Falls, MT 59405
Mailing address
1400 29TH St S
Great Falls, MT 59405-5353
Phone (406) 454-2171
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0072371 | Medicaid | MT |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| U S Health Dept of Health & Human Services | Past | Accepting new patients | |
| U S Health Dept of Health & Human Services | Past | Accepting new patients |
Organizations & group practices 2
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.
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- NPI 1861409955
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312761600000",
"number": "1770577942",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 29TH ST S",
"city": "GREAT FALLS",
"state": "MT",
"postal_code": "594055353",
"telephone_number": "406-454-2171",
"fax_number": "406-771-3021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3000 15TH AVE SOUTH",
"city": "GREAT FALLS",
"state": "MT",
"postal_code": "59405",
"telephone_number": "406-454-2171",
"fax_number": "406-771-3021"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "SUZANNE",
"middle_name": "L",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-02",
"last_updated": "2011-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "MT",
"license": "7782",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0072371",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Great Falls, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 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.