John Carroll Shively, M.D.

Primary specialty

Occupational Medicine PhysicianTaxonomy code 2083X0100X

License

01032390A Issued in IN

Practice address

3701 State Road 26 E
Lafayette, IN 47905-4808

Phone

(765) 448-5800

Fax

(765) 448-2032

NPI assigned

Nov 14, 2007

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1194998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194998400000",
    "number": "1770763153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3701 STATE ROAD 26 E",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479054808",
            "telephone_number": "765-448-5800",
            "fax_number": "765-448-2032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 STATE ROAD 26 E",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479054808",
            "telephone_number": "765-448-5800",
            "fax_number": "765-448-2032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIVELY",
        "first_name": "JOHN",
        "middle_name": "CARROLL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-14",
        "last_updated": "2007-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "IN",
            "license": "01032390A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Medicine Physician in Lafayette, IN
• Providers in Lafayette, IN by specialty
• Occupational Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.