Tanna Marie Shaw, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

220758 Issued in OK

Practice address

15318 N May Ave Ste B
Edmond, OK 73013-8864

Phone

(405) 970-8020

Fax

(405) 970-8025

NPI assigned

Jun 28, 2006

Last updated

Mar 6, 2023By 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

Other names 1

• Tanna Shaw Leibold Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Nov 13, 2022 through Nov 13, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tanna.shaw@16094314627076.direct.elationemr.com

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.

• PHP Ok PC

  dba Primary Health Partners

  • Family Medicine Physician
  • Edmond, OK
  • NPI 1235848466
  NPD
• Inpatient Consultants of Texas, PLLC

  dba Inpatient Consultants of Oklahoma, PLLC

  • Hospitalist Physician
  • Edmond, OK
  • NPI 1144274655

  Internal Medicine

  NPD (past)
• Integris Rural Health Inc

  dba INTEGRIS NW Medical Group

  • Family Medicine Physician
  • Enid, OK
  • NPI 1487800512

  Internal Medicine

  NPD (past)
• Summit Medical Center

  • General Acute Care Hospital
  • Edmond, OK
  • NPI 1356574560
  NPD (past)

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678060800000",
    "number": "1962430363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15318 N MAY AVE STE B",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730138864",
            "telephone_number": "405-970-8020",
            "fax_number": "405-970-8020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15318 N MAY AVE STE B",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730138864",
            "telephone_number": "405-970-8020",
            "fax_number": "405-970-8025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "TANNA",
        "middle_name": "MARIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-28",
        "last_updated": "2023-03-06",
        "certification_date": "2023-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "220758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TANNA",
            "last_name": "LEIBOLD",
            "middle_name": "SHAW",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David A Shaw
• Jackie L. Shaw, M.ED,, LPC, LMFT
• Joey N. Shaw, M. ED LPC
• Karis K. Shaw, RBT
• Mahogony Dajuan Shaw
• Tina Zell Shaw
• Tra'Vant'E Keagon Shaw
• Shawn a Khavari, PLLC
• Shawn Smith Optimal PT and Performance, PLLC
• Shawn Smith Optimal PT and Performance, PLLC (ARC Athletic Recovery & Rehabilitation)

• Internal Medicine Physician in Edmond, OK
• Providers in Edmond, OK by specialty
• Internal Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2023; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.