Kerry Kathleen Shuffelbottom, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2131 Issued in SC

Practice address

200 Blue Moon Xing Ste 203
Pooler, GA 31322-9698

Phone

(912) 590-0973

Fax

(912) 590-0180

NPI assigned

Jan 28, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

81.8 of 100Reported as group

Quality

77.71

Promoting interoperability

95

Improvement activities

40

Cost

65.81

Merit-based Incentive Payment System (MIPS)

Final score

87.64 of 100Reported as group

Quality

76.13

Improvement activities

40

Cost

69.23

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kerry.shuffelbottom.1@16403.direct.athenahealth.com

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.

• Infinite Medical PC

  • Family Medicine Physician
  • Bristol, RI
  • NPI 1407483175

  GA

  Medicare reassignment
• Sypert Institute PA

  • Physical Medicine & Rehabilitation Physician
  • Bonita Springs, FL
  • NPI 1699960435
  NPD (past)

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

{
    "created_epoch": "1296172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697068800000",
    "number": "1902102676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5191 FIRST COAST TECH PKWY FL 3",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322240609",
            "telephone_number": "904-223-3321",
            "fax_number": "904-223-2169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 BLUE MOON XING STE 203",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313229698",
            "telephone_number": "912-590-0973",
            "fax_number": "912-590-0180"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3408 Trout St",
            "address_purpose": "LOCATION",
            "city": "Brunswick",
            "state": "GA",
            "postal_code": "315203622",
            "country_code": "US",
            "telephone_number": "912-590-0973",
            "fax_number": "912-590-0180",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHUFFELBOTTOM",
        "first_name": "KERRY",
        "middle_name": "KATHLEEN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-28",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SC",
            "license": "2131",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "2131",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "Y06PS",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0032613-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Serenity Consultants, LLC
• Helen Dawn Seymour
• Cameron Sharkins
• Keana Shaw
• Teri Ashlea Shoop
• Ethan Daniel Shuford
• Brandon Siaj, DMD
• Whitney Sigler, BT
• Mikaela Simmons
• Trickera T Sims, FNP-BC

• Physician Assistant in Pooler, GA
• Providers in Pooler, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.