NPIMap

Individual provider Active NPI

Shelly Diane Sedberry, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Joplin, MO
National Provider Identifier
1770978074
Registry record updated Apr 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
2018010120 Issued in MO
Practice address
1801 W 32ND St BLDG C
Joplin, MO 64804
Phone
(405) 819-8013
NPI assigned
Apr 2, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 15, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 12-00438 KS
Foot & Ankle Surgery Podiatrist 213ES0103X 2018010120 MO Primary

Addresses

Primary practice location

1801 W 32ND St BLDG C
Joplin, MO 64804

Mailing address

PO Box 4427
Joplin, MO 64803-4427
Phone (417) 622-0648

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180523000729 MO Practitioner - Podiatry 8426379041 Reassigns benefits to 1 organization
I20181212002356 TX Practitioner - Podiatry 8426379041 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1801 W 32ND St
Building C Suite 102
Joplin, MO 64804-1528
Phone (417) 622-0648

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
0

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue97
Removal of skin lesions36
Removal of nail tissue182
Removal or shaving of skin growth43

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Shoal Creek Foot and Ankle Center LLC Foot & Ankle Surgery CurrentSince Nov 1, 2018 Accepting new patients
Shoal Creek Foot and Ankle Center LLC Foot & Ankle Surgery CurrentSince Nov 1, 2018 Accepting new patients
Northeastern Tribal Health System CurrentSince Jan 1, 2019 Accepting new patients
Shoal Creek Foot and Ankle Center LLC Foot & Ankle Surgery PastSince Oct 13, 2019 Accepting new patients

Locations

1801 W 32nd St
Bldg C
Joplin, MO 64804
Phone (417) 622-0648

1801 W 32nd St
Ste 102
Joplin, MO 64804
Phone (417) 622-0648

1911 S National Ave
Ste 408
Springfield, MO 65804
Phone (417) 863-1310

4136 S McCann Ct
Springfield, MO 65804
Phone (417) 755-7612

7600 S Highway 69A
Miami, OK 74354
Phone (918) 542-1655

Interoperability endpoints

  • Direct secure messaging: sedberry@scfaacl-mo.direct.office.nextgen.com
  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 4

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1427932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586908800000",
    "number": "1770978074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4427",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648034427",
            "telephone_number": "417-622-0648",
            "fax_number": "417-622-0497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 W 32ND ST BLDG C",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "64804",
            "telephone_number": "405-819-8013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEDBERRY",
        "first_name": "SHELLY",
        "middle_name": "DIANE",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-02",
        "last_updated": "2020-04-15",
        "certification_date": "2020-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "KS",
            "license": "12-00438",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MO",
            "license": "2018010120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Joplin, MO

Sources for this page

Verify at the official NPI Registry.