NPIMap

Organization Active NPI

Jeffrey R Shuart MD PC

  • Family Medicine Physician
  • Blackwell, OK
National Provider Identifier
1972638773
Registry record updated Oct 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
18498 Issued in OK
Legal business name
JEFFREY R SHUART MD PC
Practice address
115 W Bridge Ave
Blackwell, OK 74631-2800
Phone
(580) 363-3501
Fax
(580) 363-3477
NPI assigned
Feb 22, 2007
Last updated
Oct 10, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2016

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

Authorized official

Name
Jeffrey R Shuart, MDNPI 1114923489
Title
President
Phone
(580) 363-0052

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 18498 OK Primary

Addresses

Primary practice location

115 W Bridge Ave
Blackwell, OK 74631-2800

Mailing address

115 W Bridge Ave
Blackwell, OK 74631-2800
Phone (580) 363-3501

Other identifiers 1

IdentifierTypeStateIssuer
100751170AMedicaidOK

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476057600000",
    "number": "1972638773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 W BRIDGE AVE",
            "city": "BLACKWELL",
            "state": "OK",
            "postal_code": "746312800",
            "telephone_number": "580-363-3501",
            "fax_number": "580-363-3477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 W BRIDGE AVE",
            "city": "BLACKWELL",
            "state": "OK",
            "postal_code": "746312800",
            "telephone_number": "580-363-3501",
            "fax_number": "580-363-3477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY R SHUART MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2016-10-10",
        "status": "A",
        "authorized_official_last_name": "SHUART",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "580-363-0052",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "18498",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100751170A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blackwell, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2016; 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.