Active NPI
Donald Andrew Shaw, LCSW
- Clinical Social Worker
- Beaverton, OR
National Provider Identifier
1780696005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- L4086
- Practice address
- 15100 SW Koll Pkwy
Suite a
Beaverton, OR 97006-6026 - Phone
- (503) 290-6477
- NPI assigned
- Aug 13, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | L4086 | OR | Primary |
Addresses
Primary practice location
15100 SW Koll Pkwy
Suite a
Beaverton, OR 97006-6026
Mailing address
15100 SW Koll Pkwy
Suite a
Beaverton, OR 97006-6026
Phone (503) 290-6477
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 357602 | Other | MD | MHN |
| 7734703 | Other | MD | AETNA |
| 407367300 | Medicaid | MD | |
| A2840146 | Other | DC | BCBS OF DC |
| 64529901 | Other | MD | BCBS OF MD |
| 796986000 | Other | MD | MAGELLAN |
| 254442 | Other | MD | KAISER |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L4086 | OR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314835200000",
"number": "1780696005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15100 SW KOLL PKWY",
"address_2": "SUITE A",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970066026",
"telephone_number": "503-290-6477"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15100 SW KOLL PKWY",
"address_2": "SUITE A",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970066026",
"telephone_number": "503-290-6477"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "DONALD",
"middle_name": "ANDREW",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-13",
"last_updated": "2011-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "L4086",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHN",
"identifier": "357602",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7734703",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "407367300",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF DC",
"identifier": "A2840146",
"state": "DC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF MD",
"identifier": "64529901",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "796986000",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KAISER",
"identifier": "254442",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 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.