Active NPI
Michele B Shackelford, M.D.
- Emergency Medical Services (Emergency Medicine) Physician
- Chandler, AZ
National Provider Identifier
1811079940
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medical Services (Emergency Medicine) Physician
- License
- 25735
- Practice address
- 475 S Dobson Rd
Chandler, AZ 85224-5605 - Phone
- (480) 917-1648
- NPI assigned
- Oct 19, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medical Services (Emergency Medicine) Physician | 207PE0004X | 25735 | AZ | Primary |
Addresses
Primary practice location
475 S Dobson Rd
Chandler, AZ 85224-5605
Mailing address
7745 E Roland Cir
Mesa, AZ 85207-1172
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AZ0736120 | Other | AZ | BC/BS |
| 398140-08 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Emergency Medicine
- Education
- University of Arizona College of Medicine, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
4760 E Germann Rd
Gilbert, AZ 85297-0205
Phone (888) 732-3317
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25735 | AZ | MD | Emergency Medical Services (Emergency Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tec Emergency Physicians of Arizona, LLC | Current | Accepting new patients | |
| Critical Care Consultants LLC | Current | Accepting new patients | |
| Chandler Emergency Medical Group, LLC | Current | Accepting new patients | |
| Team Physicians of Arizona PC | Past | Accepting new patients |
Locations
1955 W Frye Rd
Chandler, AZ 85224
Phone (480) 507-2961
4760 E Germann Rd
Gilbert, AZ 85297
Phone (480) 494-5000
3555 S Val Vista Dr
Gilbert, AZ 85297
Phone (480) 434-4356
1419 W Hunt Hwy
San Tan Vly, AZ 85143
Phone (480) 245-4300
5125 S Rural Rd
Tempe, AZ 85282
Phone (480) 306-8780
Organizations & group practices 4
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.
-
- Emergency Care Clinic/Center
- Gilbert, AZ
- NPI 1245772870
-
- Emergency Medicine Physician
- Chandler, AZ
- NPI 1104871961
-
- Critical Care Medicine (Internal Medicine) Physician
- Gilbert, AZ
- NPI 1669511432
-
- Emergency Medicine Physician
- Mesa, AZ
- NPI 1710915764
Hospital & facility affiliations 11
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Mesa, AZ
- NPI 1689121188
-
- General Acute Care Hospital
- Chandler, AZ
- NPI 1700910189
-
- General Acute Care Hospital
- Gilbert, AZ
- NPI 1992735088
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360281600000",
"number": "1811079940",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7745 E ROLAND CIR",
"city": "MESA",
"state": "AZ",
"postal_code": "852071172"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "475 S DOBSON RD",
"city": "CHANDLER",
"state": "AZ",
"postal_code": "852245605",
"telephone_number": "480-917-1648"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHACKELFORD",
"first_name": "MICHELE",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-19",
"last_updated": "2013-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "207PE0004X",
"taxonomy_group": "",
"desc": "Emergency Medicine, Emergency Medical Services",
"state": "AZ",
"license": "25735",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "AZ0736120",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "398140-08",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chandler, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2013; 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.