Kimberly Danielle Shaw, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085-003355 Issued in IL

Practice address

31 W 155TH St
Harvey, IL 60426-3556

Phone

(708) 596-5177

Fax

(708) 596-5518

NPI assigned

Nov 14, 2008

Last updated

Jul 18, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Kimberly Danielle Young Other name

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Family Christian Health Center

  • Federally Qualified Health Center (FQHC)
  • Harvey, IL
  • NPI 1093855736
  Medicare reassignment NPD (past)
• Family Christian Health Center

  dba FCHC-Integrative Health and Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Harvey, IL
  • NPI 1013744325
  NPD
• Midwest Physician Group LTD

  • Physical Therapy Clinic/Center
  • Olympia Fields, IL
  • NPI 1053599167
  NPD (past)

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

{
    "created_epoch": "1226620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721260800000",
    "number": "1942454186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 W 155TH ST",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604263556",
            "telephone_number": "708-596-5177",
            "fax_number": "708-596-5518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 W 155TH ST",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604263556",
            "telephone_number": "708-596-5177",
            "fax_number": "708-596-5518"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3201 S Wallace St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606163501",
            "country_code": "US",
            "telephone_number": "312-326-1615",
            "fax_number": "312-326-3910",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAW",
        "first_name": "KIMBERLY",
        "middle_name": "DANIELLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-14",
        "last_updated": "2024-07-18",
        "certification_date": "2024-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-003355",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "01616617",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "085003355",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "YOUNG",
            "middle_name": "DANIELLE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Scottlab, LTD.
• Maya Rae Searcy
• Serenity Haven Care NFP
• Shankar C Sanwalani MD and Associates
• Sharonda A Shaw-Berrocal, DO
• Sheth Sushil a MD SC
• Sushil A Sheth, MD
• Robert Singh, MD
• Trina Sircar, DO
• Diane Smith, NP

• Physician Assistant in Harvey, IL
• Providers in Harvey, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.