Dustin Shackleton, M.D.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

LL17906 Issued in OR

Practice address

10123 SE Market St
Portland, OR 97216-2532

Phone

(310) 225-3244

Fax

(310) 698-7054

NPI assigned

Dec 2, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR, CA2 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 2

Specialty

Pathology

Education

University of California, Davis School of Medicine, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northwest Medical Foundation of TillamookGroup PAC ID 5092619569, 80 clinicians

Affiliated Pathologists Medical Group, Inc.Group PAC ID 7315840535, 46 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventist Health Portland Hospital, Portland, OR, CCN 380060
• Adventist Health Tillamook Hospital, Tillamook, OR, CCN 381317
• Ohsu Hospital and Clinics Hospital, Portland, OR, CCN 380009

Merit-based Incentive Payment System (MIPS)

Final score

83.81 of 100Reported as group

Quality

71.23

Promoting interoperability

88

Improvement activities

40

Cost

81.9

Merit-based Incentive Payment System (MIPS)

Final score

93.39 of 100Reported as group

Quality

88.62

Improvement activities

40

Cost

77.86

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dshackleton154799@direct.ohsu.edu

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.

• Northwest Medical Foundation of Tillamook

  • Critical Access Hospital
  • Tillamook, OR
  • NPI 1871575225
  Medicare reassignment Care Compare group NPD
• Affiliated Pathologists Medical Group, Inc.

  • Anatomic Pathology & Clinical Pathology Physician
  • Rancho Dominguez, CA
  • NPI 1730119553

  OR

  Medicare reassignment Care Compare group
• Northwest Medical Foundation of Tillamook

  • Critical Access Hospital
  • Sheridan, OR
  • NPI 1053873919
  NPD
• Northwest Medical Foundation of Tillamook

  • Rural Health Clinic/Center
  • Tillamook, OR
  • NPI 1326349416
  NPD
• Soc Pathology Medical Group Inc.

  • Anatomic Pathology & Clinical Pathology Physician
  • Rancho Dominguez, CA
  • NPI 1598081424
  NPD
• Pih Health Good Samaritan Hospital

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1508859323
  NPD (past)

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

• Northwest Medical Foundation of Tillamook

  • Land Ambulance
  • Tillamook, OR
  • NPI 1508849407

  Hospital

  Care Compare affiliation
• Northwest Medical Foundation of Tillamook

  • Critical Access Hospital
  • Tillamook, OR
  • NPI 1699146159
  Care Compare affiliation
• Northwest Medical Foundation of Tillamook

  • Rural Health Clinic/Center
  • Tillamook, OR
  • NPI 1841451853

  Hospital

  Care Compare affiliation
• Northwest Medical Foundation of Tillamook

  • Critical Access Hospital
  • Tillamook, OR
  • NPI 1871575225
  Care Compare affiliation
• Oregon Health & Science University

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1609824010
  Care Compare affiliation
• Portland Adventist Medical Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1801887658
  Care Compare affiliation

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

{
    "created_epoch": "1228176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623628800000",
    "number": "1942445119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2374 E PACIFICA PL",
            "city": "RANCHO DOMINGUEZ",
            "state": "CA",
            "postal_code": "902206214",
            "telephone_number": "310-225-3244",
            "fax_number": "310-698-7054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10123 SE MARKET ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972162532",
            "telephone_number": "310-225-3244",
            "fax_number": "310-698-7054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKLETON",
        "first_name": "DUSTIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-12-02",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "OR",
            "license": "LL17906",
            "primary": true
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "OR",
            "license": "MD150243",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DE3973",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sean Eugene Sha, M.D.
• Steven Sha, DO
• Rasheed Hassan Shabazz
• Phoebe Shabram
• Tessa Shabram
• Jason Shad, CRM, PSS
• Dana Shadburne, MA, MFT
• Lindsey Shaddy
• John Shade
• Pryor Shade

• Anatomic Pathology & Clinical Pathology Physician in Portland, OR
• Providers in Portland, OR by specialty
• Anatomic Pathology & Clinical Pathology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 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.