NPIMap

Individual provider Active NPI

Timothy Thomas Shack, M.D.

  • Internal Medicine Physician
  • Cherry Hill, NJ
National Provider Identifier
1821273616
Registry record updated Apr 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD064207L Issued in PA
Practice address
27 Covered Bridge Rd
Cherry Hill, NJ 08034-2945
Phone
(856) 429-2224
Fax
(856) 429-1926
NPI assigned
Dec 31, 2007
Last updated
Apr 10, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD064207L PA Primary

Addresses

Primary practice location

27 Covered Bridge Rd
Cherry Hill, NJ 08034-2945

Mailing address

27 Covered Bridge Rd
Cherry Hill, NJ 08034-2945
Phone (856) 429-2224

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080415000500 NJ Practitioner - Internal MedicinePractitioner - Geriatric Medicine 6305924440 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
Jefferson Medical College of Thomas Jefferson University, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Medical Office ForceGroup PAC ID 9335481951, 58 clinicians
Robert J Maro MD PAGroup PAC ID 5193627826, 15 clinicians

Practice addresses (Care Compare)

35 Beaverson Blvd
Suite 7B
Brick, NJ 08723-7860
Phone (706) 208-9700

701 Cooper Rd
Suite 16
Voorhees, NJ 08043-8007
Phone (856) 429-2224

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD064207LPAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Office Force Internal Medicine CurrentSince Aug 1, 2022 Accepting new patients
Robert J Maro MD PA Internal Medicine CurrentSince May 1, 2008 Accepting new patients
Berlin Operator LLC Past Accepting new patients
Petronilo L Seares Jr MD LLC Internal Medicine PastSince Sep 1, 2008 Accepting new patients
Elmwood Evesham Associates, LLC Past Accepting new patients

Locations

2005 Prince Ave
Athens, GA 30606
Phone (706) 296-8632

35 Beaverson Blvd
Ste 7B
Brick, NJ 08723
Phone (732) 262-2400

27 Covered Bridge Rd
Cherry Hill, NJ 08034
Phone (856) 428-6768

701 Cooper Rd
Ste 16
Voorhees, NJ 08043
Phone (856) 429-2224

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
EshyftCherry Hill, NJ, CCN 315013 Skilled nursing facility Adp of the SNF Aug 1, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1199059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334016000000",
    "number": "1821273616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 COVERED BRIDGE RD",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080342945",
            "telephone_number": "856-429-2224",
            "fax_number": "856-429-1926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27 COVERED BRIDGE RD",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080342945",
            "telephone_number": "856-429-2224",
            "fax_number": "856-429-1926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACK",
        "first_name": "TIMOTHY",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-12-31",
        "last_updated": "2012-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD064207L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cherry Hill, NJ

Sources for this page

Verify at the official NPI Registry.