NPIMap

Organization Active NPI

Rockcastle Ventures Inc. D.B.a. Callie Shaffer, M.D.

  • Pediatric Adolescent Medicine Physician
  • Mount Vernon, KY
National Provider Identifier
1962525402
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
Legal business name
ROCKCASTLE VENTURES INC. D.B.A. CALLIE SHAFFER, M.D.
Practice address
140 Newcomb Ave
Mount Vernon, KY 40456-2728
Phone
(606) 256-4148
NPI assigned
Apr 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Brandy L. Bullock
Title
Director
Phone
(606) 256-7761

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080A0000X Primary

Addresses

Primary practice location

140 Newcomb Ave
Mount Vernon, KY 40456-2728

Mailing address

PO Box 1525
Mount Vernon, KY 40456-1525
Phone (606) 256-4148

Other identifiers 1

IdentifierTypeStateIssuer
65942690MedicaidKY

Other names 1

  • Callie Shaffer, M.D. Doing business as

National Provider Directory

National Provider Directory

Locations

140 Newcomb Ave
Ste A
Mount Vernon, KY 40456
Phone (606) 256-0919

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962525402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1525",
            "city": "MOUNT VERNON",
            "state": "KY",
            "postal_code": "404561525",
            "telephone_number": "606-256-4148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 NEWCOMB AVE",
            "city": "MOUNT VERNON",
            "state": "KY",
            "postal_code": "404562728",
            "telephone_number": "606-256-4148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCKCASTLE VENTURES INC. D.B.A. CALLIE SHAFFER, M.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BULLOCK",
        "authorized_official_first_name": "BRANDY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "606-256-7761"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65942690",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Callie Shaffer, M.D.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Vernon, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.