Jacqueline Anne Shaw, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

686 County Road 39a
Southampton, NY 11968-5703

Phone

(631) 283-0355

Fax

(631) 283-2084

NPI assigned

Feb 23, 2017

Last updated

Jul 26, 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 NY

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

True North Medical Group PCGroup PAC ID 7012194806, 185 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393

Merit-based Incentive Payment System (MIPS)

Final score

93.07 of 100Reported as apm

Quality

79.77

Promoting interoperability

88.77

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

Interoperability endpoints

• Direct secure messaging: jacquelineshaw@nslijmedgr.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.

• True North Medical Group PC

  dba Orlin & Cohen Medical Specialists Group

  • Orthopaedic Surgery Physician
  • Merrick, NY
  • NPI 1659883486

  Physician Assistant

  Medicare reassignment Care Compare group NPD
• True North Medical Group PC

  dba Orlin and Cohen Medical Specialist Group

  • Oxygen Equipment & Supplies (DME)
  • Tarrytown, NY
  • NPI 1669272886
  NPD
• True North Medical Group PC

  • Cardiovascular Disease Physician
  • Bayside, NY
  • NPI 1669762258
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• University Hospital at Stony Brook

  dba Stony Brook Southampton Hospital

  • General Acute Care Hospital
  • Southampton, NY
  • NPI 1033224704
  Care Compare affiliation
• University Hospital at Stony Brook

  • General Acute Care Hospital
  • Southampton, NY
  • NPI 1225507114
  Care Compare affiliation
• University Hospital at Stony Brook

  • Land Ambulance
  • Stony Brook, NY
  • NPI 1306620588

  Hospital

  Care Compare affiliation
• University Hospital at Stony Brook

  • General Acute Care Hospital
  • Greenport, NY
  • NPI 1881690691
  Care Compare affiliation
• University Hospital at Stony Brook

  • Clinic/Center
  • Greenport, NY
  • NPI 1932466604

  Hospital

  Care Compare affiliation
• University Hospital at Stony Brook

  • General Acute Care Hospital
  • Stony Brook, NY
  • NPI 1972523348
  Care Compare affiliation

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

{
    "created_epoch": "1487808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564099200000",
    "number": "1982144911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 BELLE TERRE RD",
            "address_2": "STE 204",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771977",
            "telephone_number": "631-283-0355",
            "fax_number": "631-283-2084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "686 COUNTY ROAD 39A",
            "city": "SOUTHAMPTON",
            "state": "NY",
            "postal_code": "119685703",
            "telephone_number": "631-283-0355",
            "fax_number": "631-283-2084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "JACQUELINE",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-23",
        "last_updated": "2019-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph E Schwartz, RPH
• Pedro Ramiro Segarra, MD
• Barbara Marie Seifert, LCSW
• Dianne Sena, MSW
• Danielle Seraile, PSYD
• Peter D Shelton, PA
• Jeffrey Marc Sherwood, M.D.
• Riddhish Sheth, MD
• Sally Shukry, DO
• Robert James Sicurelli Jr., AB.DDS

• Physician Assistant in Southampton, NY
• Providers in Southampton, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 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.