Robdreka Shaw, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

2109 Issued in MS

Practice address

201 Baker Blvd
Leland, MS 38756-3401

Phone

(662) 686-4121

Fax

(662) 686-4770

NPI assigned

Oct 8, 2019

Last updated

Oct 8, 2019By 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

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Indianola Clinic LLCGroup PAC ID 4688585805, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: robdreka.shaw@dha.eclinicaldirectplus.com
• Direct secure messaging: robdrekashaw@dhaleland.allscriptsdirect.net

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.

• Indianola Clinic, LLC

  dba Leland Medical Clinic

  • Federally Qualified Health Center (FQHC)
  • Leland, MS
  • NPI 1679673917
  Medicare reassignment Care Compare group NPD
• Journey to Hope Counseling

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Greenville, MS
  • NPI 1003500562
  NPD Authorized official

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

{
    "created_epoch": "1570492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570492800000",
    "number": "1962043281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 BAKER BLVD",
            "city": "LELAND",
            "state": "MS",
            "postal_code": "387563401",
            "telephone_number": "662-686-4121",
            "fax_number": "662-686-4770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 BAKER BLVD",
            "city": "LELAND",
            "state": "MS",
            "postal_code": "387563401",
            "telephone_number": "662-686-4121",
            "fax_number": "662-686-4770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "ROBDREKA",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-08",
        "last_updated": "2019-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MS",
            "license": "2109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Ray
• Abbie Sightler Robinson, M.ED.
• Mary Catherine Ruscoe, CCC-SLP
• Analee Rose Ryals, DNP, PMHNP-BC
• Laura Selby, DPT
• Leerin D Simpson Triplett, SLP
• Gail M Sims
• Amanda Leigh Suell, OT
• Upshur Clinic, PLLC
• Melinda Balducci Upshur, FNP-BC

• Mental Health Counselor in Leland, MS
• Providers in Leland, MS by specialty
• Mental Health Counselor in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2019; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.