NPIMap

Individual provider Active NPI

Victor A Shada, D.O.

  • Family Medicine Physician
  • Crossville, TN
National Provider Identifier
1851390728
Registry record updated Apr 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1424 Issued in TN
Practice address
1264 Dayton Ave
Crossville, TN 38555-6175
Phone
(931) 484-4560
Fax
(931) 484-1480
NPI assigned
Jul 21, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 1424 TN Primary

Addresses

Primary practice location

1264 Dayton Ave
Crossville, TN 38555-6175

Mailing address

PO Box 887
Crossville, TN 38557-0887
Phone (931) 484-4560

Other identifiers 1

IdentifierTypeStateIssuer
33068751MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20040727000398 TN Practitioner - Family Practice 3476448309 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Chicago College of Osteopathy, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Victor a. Shada, D.O., P.C.Group PAC ID 2365532553, 2 clinicians

Practice addresses (Care Compare)

1264 Dayton Ave
Crossville, TN 38555-6175
Phone (931) 484-4560

Hospital & facility affiliations

  • Quality Home Health Home health agency, Jamestown, TN, CCN 447406
  • Amedisys Home Health Home health agency, Livingston, TN, CCN 447260
  • Enhabit Home Health Home health agency, Knoxville, TN, CCN 447142
  • Adoration Home Health Nashville South Home health agency, Cookeville, TN, CCN 447425
  • Cumberland Medical Center Hospital, Crossville, TN, CCN 440009
  • Cookeville Regional Medical Center Hospital, Cookeville, TN, CCN 440059
  • The Preserve at Fairfield Glade Nursing home, Crossville, TN, CCN 445506

Merit-based Incentive Payment System (MIPS)

Final score
75.27 of 100Reported as individual
Quality
76.42
Improvement activities
40
Cost
48.99

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision19
Removal of tissue1-10
Removal of skin lesions19
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1424TNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Victor a. Shada, D.O., P.C. Family Medicine CurrentSince Oct 1, 2001 Accepting new patients
Longmont United Hospital Past Accepting new patients

Locations

396 S Main St
Crossville, TN 38555
Phone (931) 484-4560

1264 Dayton Ave
Crossville, TN 38555
Phone (931) 484-4560

Organizations & group practices 2

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1121904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682467200000",
    "number": "1851390728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 887",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385570887",
            "telephone_number": "931-484-4560",
            "fax_number": "931-484-1480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1264 DAYTON AVE",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385556175",
            "telephone_number": "931-484-4560",
            "fax_number": "931-484-1480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHADA",
        "first_name": "VICTOR",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-21",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "1424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33068751",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crossville, TN

Sources for this page

Verify at the official NPI Registry.