Holly Shaw, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

C0009310 Issued in MD

Practice address

4 Olivia CT
Middle River, MD 21220-1180

Phone

(443) 834-5452

NPI assigned

Mar 25, 2024

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 MD

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, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

White Square Vascular Surgery PAGroup PAC ID 5890791735, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Medstar Franklin Square Medical Center Hospital, Rosedale, MD, CCN 210015

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• White Square Vascular Surgery PA

  • Vascular Surgery Physician
  • Baltimore, MD
  • NPI 1285666008
  Medicare reassignment Care Compare group NPD

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

• Franklin Square Hospital Center, Inc

  • General Acute Care Hospital
  • Baltimore, MD
  • NPI 1184712085
  Care Compare affiliation

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

{
    "created_epoch": "1711324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1982454971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5233 KING AVE STE 208",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212374003",
            "telephone_number": "410-918-1525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 OLIVIA CT",
            "city": "MIDDLE RIVER",
            "state": "MD",
            "postal_code": "212201180",
            "telephone_number": "443-834-5452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "HOLLY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-25",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0009310",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vanessa Sabastro
• Safe Space Counseling Services, LLC
• Divyadharshini Saseendranath
• Brian R. E. Schultz, MD
• Sonali Shah
• Warren P Simms, P.A.
• Alexis Sims, M.A., ED. S.
• Smile Loft Middle River LLC
• Marissa L Smothers, LCSW-C
• Damilola O Sokefun, RN

• Physician Assistant in Middle River, MD
• Providers in Middle River, MD by specialty
• Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2024; 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.