NPIMap

Organization Active NPI

Ronald a Shockley MD a Professional Corporation

  • Infectious Disease Physician
  • Las Vegas, NV
National Provider Identifier
1861539652
Registry record updated Nov 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
Legal business name
RONALD A SHOCKLEY MD A PROFESSIONAL CORPORATION
Practice address
3483 S Eastern Ave
Las Vegas, NV 89169-3314
Phone
(702) 309-2311
Fax
(702) 309-2177
NPI assigned
Jan 31, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2024

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

Authorized official

Name
Ronald A Shockley, MDNPI 1275511263
Title
Owner
Phone
(702) 309-2311

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0200X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

3483 S Eastern Ave
Las Vegas, NV 89169-3314

Mailing address

3483 S Eastern Ave
Las Vegas, NV 89169-3314
Phone (702) 309-2311

Other practice location 1

2931 N Tenaya Way Ste 204
Las Vegas, NV 89128-0458
Phone (702) 309-2311

Other names 1

  • INFECTIOUS DISEASE PARTNERS OF NEVADA Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070524000210 NV Part B Supplier - Clinic/Group Practice 7810094976 Receives reassigned benefits from 8 practitioners
Practice locations: Las Vegas, NV

National Provider Directory

National Provider Directory

Locations

3121 S Maryland Pkwy
Ste 412
Las Vegas, NV 89109
Phone (702) 309-2311

2470 E Flamingo Rd
Las Vegas, NV 89121
Phone (702) 737-1427

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732579200000",
    "number": "1861539652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3483 S EASTERN AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891693314",
            "telephone_number": "702-309-2311",
            "fax_number": "702-309-2177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3483 S EASTERN AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891693314",
            "telephone_number": "702-309-2311",
            "fax_number": "702-309-2177"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2931 N Tenaya Way Ste 204",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891280458",
            "country_code": "US",
            "telephone_number": "702-309-2311",
            "fax_number": "702-309-2177",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RONALD A SHOCKLEY MD A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A",
        "authorized_official_last_name": "SHOCKLEY",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-309-2311",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "INFECTIOUS DISEASE PARTNERS OF NEVADA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.