Active NPI
Sandra Jean Shields, RN LCSW
- Clinical Social Worker
- Rockwall, TX
National Provider Identifier
1790895704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 18416
- Practice address
- 775 Justin Rd
Rockwall, TX 75087 - Phone
- (972) 772-4006
- Fax
- (972) 772-3547
- NPI assigned
- Aug 30, 2006
- Last updated
- Sep 16, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 18416 | TX | Primary |
| Registered Nurse | 163W00000X | 431448 | TX |
Addresses
Primary practice location
775 Justin Rd
Rockwall, TX 75087
Mailing address
PO Box 126
Rockwall, TX 75087
Phone (972) 772-4006
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00S40Y | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120208000325 | TX | Practitioner - Clinical Social Worker | 4082871769 | Practice locations: Rockwall, TX |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
775 Justin Rd
Rockwall, TX 75087-4840
Phone (972) 772-4006
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 431448 | TX | MD | Registered Nurse |
| 18416 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1284595200000",
"number": "1790895704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 126",
"city": "ROCKWALL",
"state": "TX",
"postal_code": "75087",
"telephone_number": "972-772-4006",
"fax_number": "972-772-3547"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "775 JUSTIN RD",
"city": "ROCKWALL",
"state": "TX",
"postal_code": "75087",
"telephone_number": "972-772-4006",
"fax_number": "972-772-3547"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIELDS",
"first_name": "SANDRA",
"middle_name": "JEAN",
"credential": "RN LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2010-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "18416",
"primary": true
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "TX",
"license": "431448",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00S40Y",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rockwall, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2010; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.