Active NPI
Albert Cornelius Shaw, MD
- Psychiatry Physician
- Springfield, MO
National Provider Identifier
1861504474
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- T2005016646
- Practice address
- 1300 E Bradford Pkwy
Springfield, MO 65804-4264 - Phone
- (417) 761-5000
- Fax
- (417) 761-5011
- NPI assigned
- Aug 31, 2006
- Last updated
- Oct 17, 2011
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | T2005016646 | MO | Primary |
Addresses
Primary practice location
1300 E Bradford Pkwy
Springfield, MO 65804-4264
Mailing address
1300 E Bradford Pkwy
Springfield, MO 65804-4264
Phone (417) 761-5000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T2005016646 | MO | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318809600000",
"number": "1861504474",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1300 E BRADFORD PKWY",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658044264",
"telephone_number": "417-761-5000",
"fax_number": "417-761-5011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 E BRADFORD PKWY",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658044264",
"telephone_number": "417-761-5000",
"fax_number": "417-761-5011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "ALBERT",
"middle_name": "CORNELIUS",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2011-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MO",
"license": "T2005016646",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.