Michael McShan, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

E4519 Issued in TX

Practice address

1711 S Henderson Blvd
Suite 100
Kilgore, TX 75662-3563

Phone

(903) 315-3800

Fax

(903) 984-5367

NPI assigned

Oct 26, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Etmc Physician Group Inc.

  • Cardiovascular Disease Physician
  • Tyler, TX
  • NPI 1609382662
  Medicare reassignment

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415923200000",
    "number": "1912082249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 731218",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753731218",
            "telephone_number": "903-315-3800",
            "fax_number": "903-984-5367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1711 S HENDERSON BLVD",
            "address_2": "SUITE 100",
            "city": "KILGORE",
            "state": "TX",
            "postal_code": "756623563",
            "telephone_number": "903-315-3800",
            "fax_number": "903-984-5367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCSHAN",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-26",
        "last_updated": "2014-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "E4519",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "E4519",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "TX",
            "license": "E4519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "752883733",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "00BP62",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130926203",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amalie Macpherson
• Pamela Ann Majors, OPTICIAN
• Debra McAvoy
• Clifton McKinney
• Kevin L. McNabb
• Linus Scott Medley, FNP
• Meno Group, PLLC
• Michael B Gardner PC
• Michael W. McShan, M.D., P.a.
• Mark Douglas Miller, MD

• General Practice Physician in Kilgore, TX
• Providers in Kilgore, TX by specialty
• General Practice Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.