Individual provider Active NPI

Jacob Peter Shaffer, MD

  • Anesthesiology Physician
  • Chapel Hill, NC
National Provider Identifier
1942863535
Registry record updated Jul 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
2022-02891 Issued in NC
Practice address
101 Manning Dr
Chapel Hill, NC 27514-4220
Phone
(978) 855-1402
NPI assigned
Apr 18, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 18, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 251168 NC
Anesthesiology Physician 207L00000X 2022-02891 NC Primary

Addresses

Primary practice location

101 Manning Dr
Chapel Hill, NC 27514-4220

Mailing address

2222 Forestlake Dr
Cincinnati, OH 45244-2803
Phone (978) 855-1402

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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 1

Enrollment IDStateProvider typePAC IDDetails
I20230802003169 NC Practitioner - Anesthesiology 3274866900 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Wright State University Boonshoft School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
American Anesthesiology of North Carolina PLLCGroup PAC ID 2961316450, 315 clinicians
Southeast Anesthesiology Consultants PLLCGroup PAC ID 7719959873, 92 clinicians

Practice addresses (Care Compare)

1305 Glen Meade Rd
Wilmington, NC 28401-7369
Phone (910) 341-3300

2131 S 17TH St
Wilmington, NC 28401-7407
Phone (910) 343-7000

Hospital & facility affiliations

  • Novant Health New Hanover Regional Medical Center Hospital, Wilmington, NC, CCN 340141
  • Novant Health Brunswick Medical Center Hospital, Supply, NC, CCN 340158

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2022-02891NCMDAnesthesiology Physician
251168NCMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
American Anesthesiology of North Carolina, PLLC Anesthesiology CurrentSince Jul 19, 2024 Accepting new patients
Southeast Anesthesiology Consultants, PLLC Anesthesiology CurrentSince Jul 1, 2023 Accepting new patients
Southeast Anesthesiology Consultants, PLLC Anesthesiology Current Accepting new patients
American Anesthesiology of North Carolina, PLLC Anesthesiology CurrentSince Jul 19, 2024 Accepting new patients

Locations

1168 E Cutlar Crossing
Ste 101
Leland, NC 28451
Phone (910) 332-1550

1333 S Dickinson Dr
Unit 120
Leland, NC 28451
Phone (910) 763-2361

4420 Lake Boone Trl
Raleigh, NC 27607
Phone (919) 784-3034

924 N Howe St
Southport, NC 28461
Phone (910) 457-3800

2520 Independence Blvd
Ste 200
Wilmington, NC 28412
Phone (910) 442-1100

5301 Wrightsville Ave
Wilmington, NC 28403
Phone (910) 452-8100

105 Scotts Hill Medical Dr
Wilmington, NC 28411
Phone (910) 686-2840

2131 S 17th St
Wilmington, NC 28401
Phone (910) 342-3000

1305 Glen Meade Rd
Wilmington, NC 28401
Phone (910) 815-6100

1305 Walt Whitman Rd
Ste 300
Melville, NY 11747
Phone (516) 370-3796

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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": "1555545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689638400000",
    "number": "1942863535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 FORESTLAKE DR",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452442803",
            "telephone_number": "978-855-1402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MANNING DR",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275144220",
            "telephone_number": "978-855-1402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFFER",
        "first_name": "JACOB",
        "middle_name": "PETER",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-18",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NC",
            "license": "251168",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NC",
            "license": "2022-02891",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chapel Hill, NC

Sources for this page

Verify at the official NPI Registry.