Individual provider Active NPI

Shawn Childress

  • Anesthesiologist Assistant
  • Charleston, SC
National Provider Identifier
1962839209
Registry record updated May 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
License
87 Issued in SC
Practice address
1064 Gardner Rd Ste 112
Charleston, SC 29407-5768
Phone
(843) 723-3441
NPI assigned
Oct 1, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiologist Assistant 367H00000X 6906
Anesthesiologist Assistant 367H00000X 87 SC Primary

Addresses

Primary practice location

1064 Gardner Rd Ste 112
Charleston, SC 29407-5768

Mailing address

PO Box 603484
Charlotte, NC 28260-3484
Phone (803) 765-1732

Other practice location 1

2095 Henry Tecklenburg Dr
Charleston, SC 29414-5733
Phone (843) 402-1436

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20131031001364 GA Practitioner - Anesthesiology Assistant 8729213640 Reassigns benefits to 4 organizations
I20211213002504 SC Practitioner - Anesthesiology Assistant 8729213640 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Trident Anesthesia Group LLCGroup PAC ID 5294631545, 121 clinicians

Practice addresses (Care Compare)

9330 Medical Plaza Dr
Charleston, SC 29406-9104
Phone (843) 797-7000

Hospital & facility affiliations

  • Trident Medical Center Hospital, Charleston, SC, CCN 420079

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Associate of Arts

State licenses

LicenseStateTypeSpecialty
87SCMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Northlake Anesthesia Professionals, LLC CurrentSince Sep 19, 2013 Accepting new patients
American Anesthesiology Associates of Georgia, LLC CurrentSince Jul 1, 2020 Accepting new patients
Bon Secours St. Francis Xavier Hospital, Inc. CurrentSince Oct 1, 2021 Accepting new patients
Trident Anesthesia Group, LLC CurrentSince Jan 15, 2024 Accepting new patients
Anesthesia Associates of Charleston, P.a. CurrentSince Oct 22, 2023 Accepting new patients
Bon Secours St Francis Xavier Hospital, Inc. CurrentSince Oct 1, 2021 Accepting new patients
Piedmont Anesthesia Associates, L.L.C CurrentSince Sep 1, 2020 Accepting new patients
Bon Secours St. Francis Xavier Hospital, Inc. CurrentSince Feb 23, 2025 Accepting new patients

Locations

303 Parkway Dr NE
Atlanta, GA 30312
Phone (404) 265-4000

1800 Howell Mill Rd NW
Ste 250
Atlanta, GA 30318
Phone (404) 537-4910

1984 Peachtree Rd NW
Ste 515
Atlanta, GA 30309
Phone (404) 351-1754

2701 N Decatur Rd
Decatur, GA 30033
Phone (404) 501-1000

777 Hemlock St
Macon, GA 31201
Phone (478) 474-5600

745 Poplar Rd
Newnan, GA 30265
Phone (404) 478-8785

1491 Montreal Rd
Tucker, GA 30084
Phone (770) 270-1284

2095 Henry Tecklenburg Dr
Charleston, SC 29414
Phone (843) 402-1037

1064 Gardner Rd
Ste 112
Charleston, SC 29407
Phone (843) 723-3441

423 Barony St
Moncks Corner, SC 29461

9313 Medical Plaza Dr
Ste 102
North Charleston, SC 29406
Phone (843) 572-1228

9330 Medical Plaza Dr
North Charleston, SC 29406
Phone (843) 554-6366

295 Midland Pkwy
Summerville, SC 29485
Phone (843) 554-6366

Organizations & group practices 9

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 1

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": "1380585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715644800000",
    "number": "1962839209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 603484",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282603484",
            "telephone_number": "803-765-1732",
            "fax_number": "803-765-1732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1064 GARDNER RD STE 112",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294075768",
            "telephone_number": "843-723-3441"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2095 Henry Tecklenburg Dr",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294145733",
            "country_code": "US",
            "telephone_number": "843-402-1436",
            "fax_number": "843-402-1833",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHILDRESS",
        "first_name": "SHAWN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-10-01",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": null,
            "license": "6906",
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "SC",
            "license": "87",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.