Carolyn M. Shore, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

G060321 Issued in CA

Practice address

920 Grand Ave
Marin County Health Clinics
San Rafael, CA 94901-3506

Phone

(415) 499-6841

Fax

(415) 499-6855

NPI assigned

Oct 4, 2006

Sex

Female

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 CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: cshore585288@direct.ochin.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.

• Marin General Hospital

  • General Acute Care Hospital
  • Greenbrae, CA
  • NPI 1396725677
  NPD (past)
• Sutter Bay Hospitals

  • General Acute Care Hospital
  • Novato, CA
  • NPI 1104059153
  NPD (past)

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1831285444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 GRAND AVE",
            "address_2": "MARIN COUNTY HEALTH CLINICS",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949013506",
            "telephone_number": "415-499-6841",
            "fax_number": "415-499-6855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 GRAND AVE",
            "address_2": "MARIN COUNTY HEALTH CLINICS",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949013506",
            "telephone_number": "415-499-6841",
            "fax_number": "415-499-6855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORE",
        "first_name": "CAROLYN",
        "middle_name": "M.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G060321",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G603210",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Frank Larry Sherwood Jr.
• David Shevick, L.AC.
• John C Shin, M.D.
• Katherine Shine, M.S.
• Sharon Shirado, RDA
• Elizaveta Shostakovich, MD
• Barbara Shreibman, FNP
• Andrew Yu-Shin Shu
• Carolyn Beth Shulman, MSW, ACSW
• Jeremy Ross Shumaker, O.D.

• Internal Medicine Physician in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.