Active NPI
Shelly Styons Harkins, MD
- Family Medicine Physician
- Granger, IN
National Provider Identifier
1922093871
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 01076599A
- Practice address
- 6913 N Main St
Granger, IN 46530-8039 - Phone
- (574) 647-1500
- Fax
- (574) 243-4310
- NPI assigned
- Sep 16, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036-107483 | IL | |
| Family Medicine Physician | 207Q00000X | 01076599A | IN | Primary |
| Hospitalist Physician | 208M00000X | 036.107483 | IL | |
| Hospice and Palliative Medicine (Family Medicine) Physician | 207QH0002X | 01076599A | IN |
Addresses
Primary practice location
6913 N Main St
Granger, IN 46530-8039
Mailing address
710 N Niles Ave
South Bend, IN 46617-1924
Phone (574) 647-1610
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201394170 | Medicaid | IN |
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 |
|---|---|---|---|
| 036-107483 | IL | MD | Family Medicine Physician |
| 01076599A | IN | MD | Hospice and Palliative Medicine (Family Medicine) Physician |
| 036.107483 | IL | MD | Hospitalist Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126828800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478476800000",
"number": "1922093871",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "710 N NILES AVE",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466171924",
"telephone_number": "574-647-1610",
"fax_number": "574-237-6069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6913 N MAIN ST",
"city": "GRANGER",
"state": "IN",
"postal_code": "465308039",
"telephone_number": "574-647-1500",
"fax_number": "574-243-4310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARKINS",
"first_name": "SHELLY",
"middle_name": "STYONS",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-16",
"last_updated": "2016-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036-107483",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "01076599A",
"primary": true
},
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "IL",
"license": "036.107483",
"primary": false
},
{
"code": "207QH0002X",
"taxonomy_group": "",
"desc": "Family Medicine, Hospice and Palliative Medicine",
"state": "IN",
"license": "01076599A",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201394170",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Granger, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.