Active NPI
David Clayton Shinstrom, M.D.
- Family Medicine Physician
- Eastsound, WA
National Provider Identifier
1902833007
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 17180
- Practice address
- 1286 Mount Baker Rd Ste B102
Eastsound, WA 98245-8931 - Phone
- (360) 376-7778
- Fax
- (360) 376-7706
- NPI assigned
- Jun 26, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 17180 | WA | Primary |
Addresses
Primary practice location
1286 Mount Baker Rd Ste B102
Eastsound, WA 98245-8931
Mailing address
1286 Mount Baker Rd Ste B102
Eastsound, WA 98245-8931
Phone (360) 376-7778
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8156101 | Medicaid | WA |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17180 | WA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325808000000",
"number": "1902833007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1286 MOUNT BAKER RD STE B102",
"city": "EASTSOUND",
"state": "WA",
"postal_code": "982458931",
"telephone_number": "360-376-7778",
"fax_number": "360-376-7706"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1286 MOUNT BAKER RD STE B102",
"city": "EASTSOUND",
"state": "WA",
"postal_code": "982458931",
"telephone_number": "360-376-7778",
"fax_number": "360-376-7706"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHINSTROM",
"first_name": "DAVID",
"middle_name": "CLAYTON",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-26",
"last_updated": "2012-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "17180",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8156101",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eastsound, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.