Tristan J Shockley, MD

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

D0068884 Issued in MD

Practice address

14205 Park Center Dr
Suite 204
Laurel, MD 20707-5246

Phone

(240) 786-1001

NPI assigned

Feb 14, 2007

Sex

Male

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 DC, MD, DE, FL4 enrollments

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 4

Specialty

Physical Medicine and Rehabilitation

Education

Other, 2010

Medicare assignment

May accept Medicare assignment

Group practices

Choice Pain and Rehabilitation Center LLCGroup PAC ID 1850534645, 13 clinicians

Maryland Center for Arthritis and Regenerative Care LLCGroup PAC ID 8325447337, 2 clinicians

Charlotte Pain Management Center IncGroup PAC ID 6800962176, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Assisted Home Health Inc Home health agency, Punta Gorda, FL, CCN 683178

Merit-based Incentive Payment System (MIPS)

Final score

24.79 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

82.63

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/3611/brand/1/csg/1/fhir/r4
• Direct secure messaging: tristan.shockley.1@3611.direct.athenahealth.com

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.

• Choice Pain & Rehabilitation Center, LLC

  • Physical Medicine & Rehabilitation Physician
  • Lanham, MD
  • NPI 1568809598

  DC, DE, MD, Physical Medicine & Rehabilitation

  Medicare reassignment Care Compare group NPD Authorized official
• Maryland Ambulatory Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Lanham, MD
  • NPI 1487280871

  DC

  Medicare reassignment NPD Authorized official
• Maryland Center for Arthritis and Regenerative Care LLC

  • Nurse Practitioner
  • Catonsville, MD
  • NPI 1750963690

  MD

  Medicare reassignment Care Compare group NPD
• Charlotte Pain Management Center Inc

  • General Practice Physician
  • Port Charlotte, FL
  • NPI 1275797714

  FL

  Medicare reassignment Care Compare group NPD
• Choice Pain & Rehabilitation Center

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Newark, DE
  • NPI 1053007898
  NPD Authorized official
• Choice Recovery House

  • General Practice Physician
  • Newark, DE
  • NPI 1306539226
  NPD Authorized official
• Choice Pain & Rebabilitation Center LLC

  • Non-Pharmacy Dispensing Site
  • Bowie, MD
  • NPI 1922469865
  NPD (past) Authorized official
• Choice Pain & Rehabilitation Center

  • Clinical Medical Laboratory
  • Lanham, MD
  • NPI 1891152096
  NPD (past) Authorized official
• Choice Pain & Rehabilitation Center LLC

  • Adult Mental Health Clinic/Center
  • Columbia, MD
  • NPI 1871135947
  NPD (past) Authorized official
• Choice Pain and Rehabilitation Center

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Oxon Hill, MD
  • NPI 1427508878
  NPD (past) Authorized official
• Choice Pain and Rehabilitation Center

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Baltimore, MD
  • NPI 1588115554
  NPD (past) Authorized official
• Choice Pain & Rehabilitation Center

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Milford, DE
  • NPI 1134815970
  NPD (past) Authorized official

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Assisted Home Health Inc.

  • Home Health Agency
  • Punta Gorda, FL
  • NPI 1497177604
  Care Compare affiliation

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625011200000",
    "number": "1932242542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9900 GREENBELT RD",
            "address_2": "SUITE E117",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207062255",
            "telephone_number": "240-786-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14205 PARK CENTER DR",
            "address_2": "SUITE 204",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207075246",
            "telephone_number": "240-786-1001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOCKLEY",
        "first_name": "TRISTAN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-14",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "DC",
            "license": "MD038330",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MD",
            "license": "D0068884",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Laurel, MD
• Physical Medicine & Rehabilitation Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2021; 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.