NPIMap

Individual provider Active NPI

Anthony Shaheen, PA-C

  • Physician Assistant
  • Marietta, GA
National Provider Identifier
1942805239
Registry record updated Apr 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
61 Whitcher St NE Ste 3110
Marietta, GA 30060-1179
Phone
(770) 422-2326
NPI assigned
Dec 3, 2020
Last updated
Apr 22, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

61 Whitcher St NE Ste 3110
Marietta, GA 30060-1179

Mailing address

61 Whitcher St NE Ste 3110
Marietta, GA 30060-1179
Phone (770) 422-2326

Other practice location 1

6032 Headlands Ct
Belmont, NC 28012-6746
Phone (704) 819-3791

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ashaheen403395@directwellstar.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, CO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210310001353 GA Practitioner - Physician Assistant 7618383035 Reassigns benefits to 2 organizations
I20230721000196 CO Practitioner - Physician Assistant 7618383035 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Steadman Clinic Professional LLCGroup PAC ID 7719876226, 77 clinicians

Practice addresses (Care Compare)

1050 Wellington Ave
Imh Wellington Lung and Sleep Clinic
Grand Junction, CO 81501-8121
Phone (970) 298-5864

2635 N 7TH St
Grand Junction, CO 81501-8209

401 Castle Creek Rd
Suite 2100
Aspen, CO 81611-1159
Phone (970) 476-1100

627 25
Grand Junction, CO 81505-6401
Phone (970) 242-3535

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
10272GAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince Mar 4, 2021 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Mar 4, 2021 Accepting new patients
Intermountain Medical Group Grand Junction, LLC CurrentSince Jul 17, 2023 Accepting new patients
Intermountain Medical Group Grand Junction, LLC CurrentSince Jul 17, 2023 Accepting new patients
St Mary's Hospital and Medical Center, Inc Past Accepting new patients

Locations

401 Castle Creek Rd
Ste 2100
Aspen, CO 81611
Phone (970) 544-1289

1050 Wellington Ave
Grand Junction, CO 81501
Phone (970) 245-4810

1050 Wellington Ave
Slp Ctr
Grand Junction, CO 81501
Phone (970) 298-5864

3950 Austell Rd
Austell, GA 30106
Phone (770) 732-3752

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

61 Whitcher St NE
Ste 3110
Marietta, GA 30060
Phone (770) 422-2326

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 8

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": "1606953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619049600000",
    "number": "1942805239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 WHITCHER ST NE STE 3110",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601179",
            "telephone_number": "770-422-2326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 WHITCHER ST NE STE 3110",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601179",
            "telephone_number": "770-422-2326"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6032 Headlands Ct",
            "address_purpose": "LOCATION",
            "city": "Belmont",
            "state": "NC",
            "postal_code": "280126746",
            "country_code": "US",
            "telephone_number": "704-819-3791",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAHEEN",
        "first_name": "ANTHONY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-03",
        "last_updated": "2021-04-22",
        "certification_date": "2021-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ashaheen403395@directwellstar.org",
            "affiliation": "N",
            "address_1": "61 Whitcher St NE Ste 3110",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300601179",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.