Mark S. Shockley, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

34175 Issued in IA

Practice address

2710 Saint Francis Dr
Suite 410
Waterloo, IA 50702-5619

Phone

(319) 272-5000

Fax

(319) 272-5264

NPI assigned

May 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IA

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

Allergy/Immunology

Education

Medical College of Wisconsin, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Covenant Medical Center IncGroup PAC ID 0244148732, 234 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercyone Waterloo Medical Center Hospital, Waterloo, IA, CCN 160067
• Sartori Memorial Hospital, Inc Hospital, Cedar Falls, IA, CCN 160040

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mshockley3936222@direct.trinity-health.org

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.

• Covenant Medical Center Inc

  • Family Medicine Physician
  • Waterloo, IA
  • NPI 1548288160
  Medicare reassignment Care Compare group NPD
• Covenant Medical Center, Inc.

  • Customized Equipment (DME)
  • Evansdale, IA
  • NPI 1851141980
  NPD

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

• Covenant Medical Center Inc

  • General Acute Care Hospital
  • Waterloo, IA
  • NPI 1700827896
  Care Compare affiliation
• Sartori Memorial Hospital Inc

  • General Acute Care Hospital
  • Cedar Falls, IA
  • NPI 1942241955
  Care Compare affiliation

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184630400000",
    "number": "1831146042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 KIMBALL AVE",
            "address_2": "LL14",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025063",
            "telephone_number": "319-272-1590",
            "fax_number": "319-272-1535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2710 SAINT FRANCIS DR",
            "address_2": "SUITE 410",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025619",
            "telephone_number": "319-272-5000",
            "fax_number": "319-272-5264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOCKLEY",
        "first_name": "MARK",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2007-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IA",
            "license": "34175",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0249706",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paul David Shepard, PA-C
• Leanne Sherburne, PHARM D, R. PH.
• John Sherret, D.O.
• Warda Shoaib, MD
• Lori A. Shockley, M.D.
• Caleb Mathew Shonk
• Moaz Sial
• Jane Donnette Sieleman, PNP
• Brian E Sims, D.O.
• Lori Lynn Sinclair, M.D.

• Anesthesiology Physician in Waterloo, IA
• Providers in Waterloo, IA by specialty
• Anesthesiology Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2007; 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.