Edward Shackleford, DO

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

42953021 Issued in WI

Practice address

10400 75TH St
Aurora Medical Center
Kenosha, WI 53142-7884

Phone

(262) 697-7000

Fax

(630) 734-1560

NPI assigned

Dec 1, 2005

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI, TX2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: eshackleford152186@direct.aspirus.org

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.

• Mercy Health System Corporation

  • Multi-Specialty Clinic/Center
  • Janesville, WI
  • NPI 1598718603
  Medicare reassignment NPD
• Lawton Indian Hospital

  • General Acute Care Hospital
  • Lawton, OK
  • NPI 1760489223

  TX

  Medicare reassignment NPD
• Mercy Health System Corporation

  • General Acute Care Hospital
  • Janesville, WI
  • NPI 1093768962
  NPD
• Mercy Health System Corporation

  • Critical Access Hospital
  • Lake Geneva, WI
  • NPI 1699728550
  NPD
• Mea-Aea Kenosha SC

  • Emergency Medicine Physician
  • Kenosha, WI
  • NPI 1477546737
  NPD (past)
• Inphynet Primary Care Physicians Midwest, S.C.

  • Physician Assistant
  • Fort Wayne, IN
  • NPI 1528090610

  Emergency Medicine

  NPD (past)
• Midwest Emergency Associates, LLC

  • Emergency Medicine Physician
  • Hoffman Estates, IL
  • NPI 1437196623
  NPD (past)
• Tri-County Emergency Physicians, LTD

  • Emergency Medicine Physician
  • Barrington, IL
  • NPI 1700810470
  NPD (past)

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

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790769800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3043",
            "address_2": "MEA AEA KENOSH SC",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605223043",
            "telephone_number": "630-734-0200",
            "fax_number": "630-734-1560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10400 75TH ST",
            "address_2": "AURORA MEDICAL CENTER",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427884",
            "telephone_number": "262-697-7000",
            "fax_number": "630-734-1560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKLEFORD",
        "first_name": "EDWARD",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "42953021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30099700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan D. Semph, DPT
• Jeffrey S Serchen, PT
• Jessica R Serpe, PHARM D
• Frank Serrecchia, M.D.
• Amy Shackelford
• Ashokkumar K Shah, M.D.
• Jesika Shah, MD
• Vicki Shah, DDS
• Juvaria Shahabuddin, M.D.
• Elika Anne Shapiro, LCSW

• Emergency Medicine Physician in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Emergency Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.