NPIMap

Individual provider Active NPI

Tavis M. Shaw, D.O.

  • Urology Physician
  • Wpafb, OH
National Provider Identifier
1871662809
Registry record updated May 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
14235720-1204 Issued in UT
Practice address
4881 Sugar Maple Dr
Wpafb, OH 45433-5529
Phone
(937) 257-9292
NPI assigned
Nov 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2026

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X OS013233 PA
Urology Physician 208800000X 34.009996 OH
Urology Physician 208800000X 14235720-1204 UT Primary
Surgery Physician 208600000X OS013233 PA

Addresses

Primary practice location

4881 Sugar Maple Dr
Wpafb, OH 45433-5529

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128

Other practice location 1

5171 S Cottonwood St Ste 210
Murray, UT 84107-5718
Phone (801) 507-3380

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Bluemark LLC/ Office Ally

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20170830000089 TX Practitioner - Urology 9638113921 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Kansas City University of Med & Biosciences, College of Osteo Med, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

4315 Diplomacy Dr
Anchorage, AK 99508-5926
Phone (907) 563-2662

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.93 of 100Reported as group
Quality
70.1
Promoting interoperability
100
Improvement activities
40
Cost
83.01

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection18

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS013233PAMDUrology Physician
14235720-1204UTMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Alaska Regional Health Consortium Current Accepting new patients
Southeast Alaska Regional Health Consortium CurrentSince Sep 6, 2023 Accepting new patients
Alaska Native Tribal Health Consortium CurrentSince Aug 1, 2017 Accepting new patients
Southeast Alaska Regional Health Consortium CurrentSince Sep 6, 2023 Accepting new patients

Locations

4315 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-1729

4000 Ambassador Dr
Anchorage, AK 99508
Phone (907) 729-1900

37 Chilkat Ave
Haines, AK 99827
Phone (907) 463-4040

3100 Channel Dr
Ste 300
Juneau, AK 99801
Phone (907) 463-4000

222 Tongass Dr
Sitka, AK 99835
Phone (907) 966-8519

Interoperability endpoints

  • Direct secure messaging: tshaw@direct.anthc.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779235200000",
    "number": "1871662809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4881 SUGAR MAPLE DR",
            "city": "WPAFB",
            "state": "OH",
            "postal_code": "454335529",
            "telephone_number": "937-257-9292"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5171 S Cottonwood St Ste 210",
            "address_purpose": "LOCATION",
            "city": "Murray",
            "state": "UT",
            "postal_code": "841075718",
            "country_code": "US",
            "telephone_number": "801-507-3380",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAW",
        "first_name": "TAVIS",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-06",
        "last_updated": "2026-05-20",
        "certification_date": "2026-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "PA",
            "license": "OS013233",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "OH",
            "license": "34.009996",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "UT",
            "license": "14235720-1204",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "OS013233",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC/ Office Ally",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CMS esMD eMDR",
            "address_1": "1300 SE Cardinal Ct Ste 190",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986839683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wpafb, OH

Sources for this page

Verify at the official NPI Registry.