Stanley J Shin, MD

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

043776 Issued in GA

Practice address

5 Grady Johnson Rd
Statesboro, GA 30458-6026

Phone

(912) 489-6246

Fax

(912) 489-6346

NPI assigned

Jun 5, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

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 1

Specialty

Cardiovascular Disease (Cardiology)

Education

Tulane University School of Medicine, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Statesboro Cardiology, PCGroup PAC ID 5294704508, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: stanley-shin@statesborocardiology.e-mdsdirect.com

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.

• Statesboro Cardiology, PC

  • Cardiovascular Disease Physician
  • Statesboro, GA
  • NPI 1205840105
  Medicare reassignment Care Compare group NPD Authorized official
• Genesis Vascular of Pooler, LLC

  • Interventional Cardiology Physician
  • Pooler, GA
  • NPI 1376930339

  Cardiovascular Disease

  NPD (past)

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507507200000",
    "number": "1801835194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 GRADY JOHNSON RD",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304586026",
            "telephone_number": "912-489-6246",
            "fax_number": "912-489-6346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 GRADY JOHNSON RD",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304586026",
            "telephone_number": "912-489-6246",
            "fax_number": "912-489-6346"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5 Grady Johnson Rd",
            "address_purpose": "LOCATION",
            "city": "Statesboro",
            "state": "GA",
            "postal_code": "304586026",
            "country_code": "US",
            "telephone_number": "912-489-6246",
            "fax_number": "912-489-6346",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIN",
        "first_name": "STANLEY",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-05",
        "last_updated": "2017-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "GA",
            "license": "043776",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "GA",
            "license": "043776",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000749053A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sherray Medical Inc
• Eric Shiflett, ATC, LAT
• Chen-Wen Shih, M.D.
• Dellarie L Shilling, FNP
• Shiloh Wound Care PC
• Whitney Ann Shingler, DIETICIAN
• Scarlet Gabrielle Shumate
• Subuhi Siddiqui, DDS
• Signature Ambulance at Statesboro LLC
• Benjamin Andrew Sikes, NP

• Cardiovascular Disease Physician in Statesboro, GA
• Providers in Statesboro, GA by specialty
• Cardiovascular Disease Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2017; 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.

Verify at the official NPI Registry.