NPIMap

Individual provider Active NPI

Shawna King, D.O.

  • Family Medicine Physician
  • Brandon, FL
National Provider Identifier
1952740599
Registry record updated Aug 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
UO3724 Issued in FL
Practice address
500 Vonderburg Dr Ste 102
Brandon, FL 33511-5968
Phone
(813) 681-5658
Fax
(813) 681-5250
NPI assigned
Jun 17, 2013
Last updated
Aug 15, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X UO3724 FL Primary

Addresses

Primary practice location

500 Vonderburg Dr Ste 102
Brandon, FL 33511-5968

Mailing address

500 Vonderburg Dr Ste 102E
Brandon, FL 33511-5968
Phone (813) 681-5658

Other practice location 1

4051 Upper Creek Dr Ste 112
Sun City Center, FL 33573
Phone (813) 681-5658

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160617001590 FL Practitioner - Family Practice 3375834567 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lake Erie College of Osteopathic Medicine, Erie, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cornerstone Medical Care of Brandon LLCGroup PAC ID 0345233409, 16 clinicians

Practice addresses (Care Compare)

500 Vonderburg Dr
Suite 102
Brandon, FL 33511-5968
Phone (813) 681-5658

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
UO3724FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cornerstone Medical Care of Brandon LLC CurrentSince Jul 1, 2019 Accepting new patients
Team Radiology Physicians, PA PastSince Aug 11, 2019 Accepting new patients

Locations

500 Vonderburg Dr
Ste 102
Brandon, FL 33511
Phone (813) 386-2547

4051 Upper Creek Dr
Ste 112
Sun City Center, FL 33573
Phone (813) 681-5658

Interoperability endpoints

  • Direct secure messaging: shawnaking@cm.allscriptsdirect.net

Organizations & group practices 2

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 11

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": "1371427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565827200000",
    "number": "1952740599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 VONDERBURG DR STE 102E",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115968",
            "telephone_number": "813-681-5658",
            "fax_number": "813-681-5250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 VONDERBURG DR STE 102",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115968",
            "telephone_number": "813-681-5658",
            "fax_number": "813-681-5250"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4051 Upper Creek Dr Ste 112",
            "address_purpose": "LOCATION",
            "city": "Sun City Center",
            "state": "FL",
            "postal_code": "33573",
            "country_code": "US",
            "telephone_number": "813-681-5658",
            "fax_number": "813-681-5250",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KING",
        "first_name": "SHAWNA",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-17",
        "last_updated": "2019-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "UO3724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, FL

Sources for this page

Verify at the official NPI Registry.