Krista E. Shackelford, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

0432039 Issued in KS

Practice address

835 N Hillside St
Wichita, KS 67214-4913

Phone

(316) 685-4395

Fax

(316) 685-1149

NPI assigned

Jul 4, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

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

Specialty

Dermatology

Education

University of Kansas School of Med (KC/Wich/Sal), 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Dermatology Clinic P aGroup PAC ID 4688621451, 6 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

77.55 of 100Reported as group

Quality

55.09

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: krista.shackelford.1@15396.direct.athenahealth.com
• Direct secure messaging: krista.shackelford@khindirect.org

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.

• The Dermatology Clinic, P a

  • Dermatopathology Physician
  • Wichita, KS
  • NPI 1932168317
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207094400000",
    "number": "1922038801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "835 N HILLSIDE ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672144913",
            "telephone_number": "316-685-4395",
            "fax_number": "316-685-1149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 N HILLSIDE ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672144913",
            "telephone_number": "316-685-4395",
            "fax_number": "316-685-1149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKELFORD",
        "first_name": "KRISTA",
        "middle_name": "E.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-04",
        "last_updated": "2008-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IN",
            "license": "01061838A",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "KS",
            "license": "0432039",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Marie Sewell
• Karla L Seymore, LMSW
• Jihane Sfeir, MD
• Sarah Shaban, MD
• Isabel Shackelford
• Michael Torey Shackelford, OTR/L
• Jamie Lynn Shaddix, APRN
• Melissa Taylor Shadoin, MD
• Matthew Shaff, DMD
• Deborah R. Shaffer-Mattal, LMSW

• Dermatology Physician in Wichita, KS
• Providers in Wichita, KS by specialty
• Dermatology Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2008; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.