NPIMap

Individual provider Active NPI

Anthony W Shallin, M.D.

  • Internal Medicine Physician
  • Georgetown, TX
National Provider Identifier
1891734968
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
J2323 Issued in TX
Practice address
3613 Williams Dr
Ste 404
Georgetown, TX 78628-1377
Phone
(512) 930-4275
Fax
(512) 930-4093
NPI assigned
Jun 5, 2006
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X J2323 TX Primary

Addresses

Primary practice location

3613 Williams Dr
Ste 404
Georgetown, TX 78628-1377

Mailing address

3613 Williams Dr
Ste 404
Georgetown, TX 78628-1377
Phone (512) 930-4275

Other names 1

  • Dr. Tony Shallin Professional name

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
I20050324000875 TX Practitioner - Internal Medicine 5294780367 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Baylor College of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

3613 Williams Dr
Suite 404
Georgetown, TX 78628-1370
Phone 512930427526

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
J2323TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kumar Sathianathan, Mdpa Internal Medicine Current Accepting new patients
Tony Shallin, Mdpa Internal Medicine CurrentSince Aug 1, 1999 Accepting new patients

Locations

3613 Williams Dr
Ste 404
Georgetown, TX 78628
Phone (512) 930-4275

902 N Austin Ave
B
Georgetown, TX 78626
Phone (512) 930-4275

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1891734968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3613 WILLIAMS DR",
            "address_2": "STE 404",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786281377",
            "telephone_number": "512-930-4275",
            "fax_number": "512-930-4093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3613 WILLIAMS DR",
            "address_2": "STE 404",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786281377",
            "telephone_number": "512-930-4275",
            "fax_number": "512-930-4093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHALLIN",
        "first_name": "ANTHONY",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-05",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "J2323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TONY",
            "last_name": "SHALLIN",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Georgetown, TX

Sources for this page

Verify at the official NPI Registry.