Active NPI
Harrison Joseph Shawa
- Dermatology Physician
- Saint Louis, MO
National Provider Identifier
1821739699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 2024019911
- Practice address
- 4590 Nash Way # 90-29928
Saint Louis, MO 63110-1020 - Phone
- (314) 747-3000
- NPI assigned
- Apr 5, 2022
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 2024019911 | MO | Primary |
Addresses
Primary practice location
4590 Nash Way # 90-29928
Saint Louis, MO 63110-1020
Mailing address
11270 Hidden Peak Ave Unit 204
Las Vegas, NV 89135-3603
Phone (775) 686-0909
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230926000644 | NV | Order and Referring Only - Dermatology | 7618321647 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2024019911 | MO | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724284800000",
"number": "1821739699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11270 HIDDEN PEAK AVE UNIT 204",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891353603",
"telephone_number": "775-686-0909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4590 NASH WAY # 90-29928",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631101020",
"telephone_number": "314-747-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAWA",
"first_name": "HARRISON",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-04-05",
"last_updated": "2024-08-22",
"certification_date": "2024-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "MO",
"license": "2024019911",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.