NPIMap

Organization Active NPI

Robert J. Shellito DPM, Inc.

  • Podiatrist
  • Warren, OH
National Provider Identifier
1942472139
Registry record updated Nov 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
36003129 Issued in OH
Legal business name
ROBERT J. SHELLITO DPM, INC.
Practice address
1543 E Market St
Warren, OH 44483-6639
Phone
(330) 392-2700
Fax
(330) 392-2707
NPI assigned
Mar 27, 2008
Last updated
Nov 21, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2012

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

Authorized official

Name
Dr. Robert Jude Shellito, DPMNPI 1821084625
Title
President/Podiatrist
Phone
(330) 534-4438

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X SC005955 PA
Podiatrist 213E00000X 36003129 OH Primary

Addresses

Primary practice location

1543 E Market St
Warren, OH 44483-6639

Mailing address

PO Box 70
Hubbard, OH 44425-0070
Phone (330) 534-4438

Other identifiers 2

IdentifierTypeStateIssuer
101757359 0002MedicaidPA
2154163MedicaidOH

Other names 1

  • Robert J. Shellito, DPM, LLC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, PA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20080516000313 OH Part B Supplier - Clinic/Group Practice 5294804290 Receives reassigned benefits from 1 practitioner
Practice locations: Warren, OH
O20080602000884 PA Part B Supplier - Clinic/Group Practice 5294804290 Receives reassigned benefits from 1 practitioner
Practice locations: Wheatland, PA; Sharon, PA; Hermitage, PA; New Castle, PA; Farrell, PA
O20100930017145 OH DME Supplier - Physician - Podiatry 5294804290 Practice locations: Warren, OH

National Provider Directory

National Provider Directory

Locations

33 Cathedral Dr
Farrell, PA 16121

179 Pearrell Dr
Sharon, PA 16146

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1206576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353456000000",
    "number": "1942472139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70",
            "city": "HUBBARD",
            "state": "OH",
            "postal_code": "444250070",
            "telephone_number": "330-534-4438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1543 E MARKET ST",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444836639",
            "telephone_number": "330-392-2700",
            "fax_number": "330-392-2707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT J. SHELLITO DPM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-27",
        "last_updated": "2012-11-21",
        "status": "A",
        "authorized_official_last_name": "SHELLITO",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JUDE",
        "authorized_official_title_or_position": "PRESIDENT/PODIATRIST",
        "authorized_official_telephone_number": "330-534-4438",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "PA",
            "license": "SC005955",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "OH",
            "license": "36003129",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101757359 0002",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2154163",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Robert J. Shellito, DPM, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Warren, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.