Active NPI
Shauna Latiece Gibson
- Contractor
- Willowick, OH
National Provider Identifier
1902442221
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Feb 20, 2024.
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- Practice address
- 31624 N Marginal Dr Apt F
Willowick, OH 44095-4422 - Phone
- (440) 529-9931
- NPI assigned
- Nov 21, 2019
- Last updated
- Nov 21, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Contractor | 171W00000X | Primary |
Addresses
Primary practice location
31624 N Marginal Dr Apt F
Willowick, OH 44095-4422
Mailing address
31624 N Marginal Dr Apt F
Willowick, OH 44095-4422
Phone (440) 529-9931
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)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1574294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574294400000",
"number": "1902442221",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31624 N MARGINAL DR APT F",
"city": "WILLOWICK",
"state": "OH",
"postal_code": "440954422",
"telephone_number": "440-529-9931"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31624 N MARGINAL DR APT F",
"city": "WILLOWICK",
"state": "OH",
"postal_code": "440954422",
"telephone_number": "440-529-9931"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "SHAUNA",
"middle_name": "LATIECE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-11-21",
"last_updated": "2019-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Willowick, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.