Active NPI
Shelley P Schoonover, MD
- Pediatrics Physician
- Los Alamos, NM
National Provider Identifier
1790779007
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 93385
- Practice address
- 3917 West Rd
Ste 128
Los Alamos, NM 87544-2275 - Phone
- (505) 662-4234
- Fax
- (505) 662-7894
- NPI assigned
- Sep 1, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 93385 | NM | Primary |
| Pediatrics Physician | 208000000X | J0249 | TX |
Addresses
Primary practice location
3917 West Rd
Ste 128
Los Alamos, NM 87544-2275
Mailing address
3917 West Rd
Ste 128
Los Alamos, NM 87544-2275
Phone (505) 662-4234
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 51342 | Medicaid | NM |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 93385 | NM | MD | Pediatrics Physician |
| J0249 | TX | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Childrens Clinic, P.a. | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- pug8539@yourcarecommunity.org
Organizations & group practices 1
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.
-
- Pediatrics Physician
- Los Alamos, NM
- NPI 1679793277
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125532800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1790779007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3917 WEST RD",
"address_2": "STE 128",
"city": "LOS ALAMOS",
"state": "NM",
"postal_code": "875442275",
"telephone_number": "505-662-4234",
"fax_number": "505-662-7894"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3917 WEST RD",
"address_2": "STE 128",
"city": "LOS ALAMOS",
"state": "NM",
"postal_code": "875442275",
"telephone_number": "505-662-4234",
"fax_number": "505-662-7894"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCHOONOVER",
"first_name": "SHELLEY",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NM",
"license": "93385",
"primary": true
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "J0249",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "51342",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Alamos, NM
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.