NPIMap

Individual provider Active NPI

Laura R Shea, D.O.

  • Family Medicine Physician
  • Weeki Wachee, FL
National Provider Identifier
1912133257
Registry record updated Sep 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS014711 Issued in FL
Practice address
10065 Cortez Blvd
Weeki Wachee, FL 34613-6389
Phone
(352) 596-4660
Fax
(352) 596-4674
NPI assigned
Jun 1, 2009
Last updated
Sep 7, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS014711 FL Primary

Addresses

Primary practice location

10065 Cortez Blvd
Weeki Wachee, FL 34613-6389

Mailing address

10065 Cortez Blvd
Weeki Wachee, FL 34613-6389
Phone (352) 596-4660

Other identifiers 2

IdentifierTypeStateIssuer
RU82UOtherBCBS
104091700MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20170831000748 FL Practitioner - Family Practice 6901922707 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lake Erie College of Osteopathic Medicine, Erie, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Idicula Medical Associates MD PAGroup PAC ID 0840290730, 6 clinicians

Practice addresses (Care Compare)

10091 Cortez Blvd
Weeki Wachee, FL 34613-6378
Phone (352) 596-4660

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.19 of 100Reported as group
Quality
76.62
Promoting interoperability
99
Improvement activities
40
Cost
77.51

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS014711FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Idicula Medical Associates MD PA CurrentSince Oct 1, 2022 Accepting new patients
St Luke Heart Institute Inc PastSince Sep 11, 2022 Accepting new patients
Dwic of Tampa Bay, Inc Past Accepting new patients
Medexpress Urgent Care, PC - Monaca Past Accepting new patients

Locations

10065 Cortez Blvd
Weeki Wachee, FL 34613
Phone (352) 596-1229

10091 Cortez Blvd
Weeki Wachee, FL 34613
Phone (352) 592-7772

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GIIBAA

Organizations & group practices 4

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 6

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": "1243814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662508800000",
    "number": "1912133257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10065 CORTEZ BLVD",
            "city": "WEEKI WACHEE",
            "state": "FL",
            "postal_code": "346136389",
            "telephone_number": "352-596-4660",
            "fax_number": "352-596-4674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10065 CORTEZ BLVD",
            "city": "WEEKI WACHEE",
            "state": "FL",
            "postal_code": "346136389",
            "telephone_number": "352-596-4660",
            "fax_number": "352-596-4674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEA",
        "first_name": "LAURA",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-01",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS014711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "RU82U",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104091700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Weeki Wachee, FL

Sources for this page

Verify at the official NPI Registry.