Active NPI
James B Shattuck
- Specialist
- Trego, WI
National Provider Identifier
1982837878
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 137046
- Practice address
- N8760 River Rd
Trego, WI 54888-9282 - Phone
- (715) 635-6442
- NPI assigned
- Aug 26, 2009
- Last updated
- Aug 26, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 137046 | WI | Primary |
Addresses
Primary practice location
N8760 River Rd
Trego, WI 54888-9282
Mailing address
N8760 River Rd
Trego, WI 54888-9282
Phone (715) 635-6442
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 137046 | WI | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251244800000",
"number": "1982837878",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N8760 RIVER RD",
"city": "TREGO",
"state": "WI",
"postal_code": "548889282",
"telephone_number": "715-635-6442"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "N8760 RIVER RD",
"city": "TREGO",
"state": "WI",
"postal_code": "548889282",
"telephone_number": "715-635-6442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHATTUCK",
"first_name": "JAMES",
"middle_name": "B",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-08-26",
"last_updated": "2009-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WI",
"license": "137046",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Trego, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.