NPIMap

Individual provider Active NPI

Gary Y. Shaw, M.D.

  • Otolaryngology/Facial Plastic Surgery Physician
  • Canton, IL
National Provider Identifier
1912940958
Registry record updated Apr 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X
License
109774 Issued in MO
Practice address
180 S Main St
Canton, IL 61520-2608
Phone
(309) 647-0201
Fax
(309) 649-6880
NPI assigned
Jun 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X 109774 MO Primary

Addresses

Primary practice location

180 S Main St
Canton, IL 61520-2608

Mailing address

180 S Main St
Canton, IL 61520-2608
Phone (309) 647-0201

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address gary.shaw@gmgil.eclinicaldirectplus.com Health Information Exchange (HIE) Graham Hospital Association

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20160307000337 IL Practitioner - Otolaryngology 8224005590 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Graham Hospital AssociationGroup PAC ID 2769375021, 124 clinicians
Mason Hospital DistrictGroup PAC ID 2466360607, 41 clinicians

Practice addresses (Care Compare)

180 S Main St
Canton, IL 61520-2608
Phone (309) 647-0201

210 W Walnut St
Canton, IL 61520-2444
Phone (309) 647-5240

615 N Promenade St
Havana, IL 62644-1243
Phone (309) 543-8510

Hospital & facility affiliations

  • Graham Hospital Association Hospital, Canton, IL, CCN 141356
  • Graham Hospital Association Hospital, Canton, IL, CCN 140001

Merit-based Incentive Payment System (MIPS)

Final score
83.26 of 100Reported as group
Quality
62.57
Promoting interoperability
100
Improvement activities
40
Cost
77.37

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision22
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mason Hospital District Current Accepting new patients
Mason Hospital District CurrentSince Oct 3, 2016 Accepting new patients
Mason Hospital District CurrentSince Oct 3, 2016 Accepting new patients
Graham Hospital Association CurrentSince Mar 1, 2016 Accepting new patients
Graham Hospital Association CurrentSince Mar 1, 2016 Accepting new patients
Mason Hospital District CurrentSince Oct 3, 2016 Accepting new patients
Graham Hospital Association Past Accepting new patients
Mason Hospital District Past Accepting new patients

Locations

180 S Main St
Canton, IL 61520
Phone (309) 647-5240

175 S Main St
Canton, IL 61520
Phone (309) 647-3937

615 N Promenade St
Havana, IL 62644
Phone (309) 543-8510

615 N Promenade St
#W200
Havana, IL 62644
Phone (309) 543-6600

Interoperability endpoints

  • Direct secure messaging: gary.shaw@gmgil.eclinicaldirectplus.com

Organizations & group practices 21

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.

View all 21

Hospital & facility affiliations 1

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": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618272000000",
    "number": "1912940958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 S MAIN ST",
            "city": "CANTON",
            "state": "IL",
            "postal_code": "615202608",
            "telephone_number": "309-647-0201",
            "fax_number": "309-649-5101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 S MAIN ST",
            "city": "CANTON",
            "state": "IL",
            "postal_code": "615202608",
            "telephone_number": "309-647-0201",
            "fax_number": "309-649-6880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "GARY",
        "middle_name": "Y.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2021-04-13",
        "certification_date": "2021-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "MO",
            "license": "109774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gary.shaw@gmgil.eclinicaldirectplus.com",
            "affiliation": "Y",
            "affiliationName": "Graham Hospital Association",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "180 S Main St",
            "city": "Canton",
            "state": "IL",
            "country_code": "US",
            "postal_code": "615202608",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Canton, IL

Sources for this page

Verify at the official NPI Registry.