NPIMap

Individual provider Active NPI

Shawn Robert O'Haver, AG-ACNP

  • Primary Care Nurse Practitioner
  • Lake Havasu City, AZ
National Provider Identifier
1922450493
Registry record updated Nov 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
AP11115 Issued in AZ
Practice address
84 Acoma Blvd N Ste 106
Lake Havasu City, AZ 86403-6096
Phone
(928) 412-8808
Fax
(928) 412-8807
NPI assigned
Jul 8, 2016
Last updated
Nov 11, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 11, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X AP11115 AZ Primary

Addresses

Primary practice location

84 Acoma Blvd N Ste 106
Lake Havasu City, AZ 86403-6096

Mailing address

84 Acoma Blvd N Ste 106
Lake Havasu City, AZ 86403-6096
Phone (928) 412-8808

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20180727002345 AZ Practitioner - Nurse Practitioner 6103173778 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1720 Mesquite Ave
Suite 100
Lake Havasu City, AZ 86403-5602
Phone (928) 505-5555

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.06 of 100Reported as group
Quality
68.27
Promoting interoperability
100
Improvement activities
40
Cost
78.59

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP11115AZMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
La Paz Regional Hospital Inc CurrentSince Oct 13, 2019 Accepting new patients
Lakeside Orthopedic Institute, LLC CurrentSince Nov 15, 2022 Accepting new patients
Lakeside Orthopedic Institute LLC Current Accepting new patients
Lakeside Orthopedic Institute LLC CurrentSince Nov 15, 2022 Accepting new patients
La Paz Regional Hospital Inc CurrentSince Oct 13, 2019 Accepting new patients
Lakeside Orthopedic Institute, LLC Past Accepting new patients
Lakeside Orthopedic Institute LLC Past Accepting new patients
Lakeside Orthopedic Institute LLC Past Accepting new patients

Locations

1720 Mesquite Ave
Ste 100
Lk Havasu Cty, AZ 86403
Phone (928) 855-1550

1944 Mesquite Ave
Lk Havasu Cty, AZ 86403
Phone (928) 505-9729

25 Riviera Blvd
Lk Havasu Cty, AZ 86403
Phone (928) 505-7246

1200 W Mohave Rd
Parker, AZ 85344
Phone (928) 669-7300

1713 S Kofa Ave
Ste A
Parker, AZ 85344
Phone (928) 669-7380

1713 S Kofa Ave
Ste K
Parker, AZ 85344
Phone (928) 669-1097

Organizations & group practices 9

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 4

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": "1467936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636588800000",
    "number": "1922450493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "84 ACOMA BLVD N STE 106",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864036096",
            "telephone_number": "928-412-8808",
            "fax_number": "928-412-8807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "84 ACOMA BLVD N STE 106",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864036096",
            "telephone_number": "928-412-8808",
            "fax_number": "928-412-8807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'HAVER",
        "first_name": "SHAWN",
        "middle_name": "ROBERT",
        "credential": "AG-ACNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-07-08",
        "last_updated": "2021-11-11",
        "certification_date": "2021-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "AZ",
            "license": "AP11115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Havasu City, AZ

Sources for this page

Verify at the official NPI Registry.