NPIMap

Individual provider Active NPI

Shawn P. Lazoff, DO

  • Family Medicine Physician
  • Summerfield, NC
National Provider Identifier
1982993309
Registry record updated Apr 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2020-04121 Issued in NC
Practice address
4431 US Highway 220 N
Summerfield, NC 27358-9411
Phone
(336) 643-7711
Fax
(336) 643-3047
NPI assigned
Apr 6, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 02004719A IN
Family Medicine Physician 207Q00000X 2020-04121 NC Primary

Addresses

Primary practice location

4431 US Highway 220 N
Summerfield, NC 27358-9411

Mailing address

100 Kimel Forest Dr
Winston Salem, NC 27103-6074
Phone (336) 716-1331

Other practice location 1

3534 Brooklyn Ave
Fort Wayne, IN 46809-1361
Phone (260) 478-5170

Other identifiers 1

IdentifierTypeStateIssuer
201337850MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address shawn.lazoff@lutheranhealthnetwork.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201216002192 NC Practitioner - Family Practice 3375787823 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Osteopathic Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wake Forest Health Network LLCGroup PAC ID 4183538895, 276 clinicians

Practice addresses (Care Compare)

4431 US Hwy 220 N
Summerfield, NC 27358-9411
Phone (336) 643-7711

Hospital & facility affiliations

  • North Carolina Baptist Hospital Hospital, Winston-Salem, NC, CCN 340047
  • Moses H. Cone Memorial Hospital, the Hospital, Greensboro, NC, CCN 340091

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
02004719AINMDFamily Medicine Physician
2020-04121NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest Health Network, LLC CurrentSince Jan 11, 2021 Accepting new patients
Wake Forest Health Network LLC Current Accepting new patients
Wake Forest Health Network LLC Family Medicine CurrentSince Jan 11, 2021 Accepting new patients
Cornerstone Health Care LLC Past Accepting new patients

Locations

905 Phillips Ave
High Point, NC 27262
Phone (336) 802-2040

4431 US Highway 220 N
Summerfield, NC 27358
Phone (336) 643-7711

100 Kimel Forest Dr
Winston Salem, NC 27103
Phone (336) 713-0947

Interoperability endpoints

  • Direct secure messaging: shawn.lazoff@lutheranhealthnetwork.cernerdirect.com

Organizations & group practices 4

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 6

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": "1302048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619740800000",
    "number": "1982993309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 KIMEL FOREST DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036074",
            "telephone_number": "336-716-1331",
            "fax_number": "336-716-3202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4431 US HIGHWAY 220 N",
            "city": "SUMMERFIELD",
            "state": "NC",
            "postal_code": "273589411",
            "telephone_number": "336-643-7711",
            "fax_number": "336-643-3047"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3534 Brooklyn Ave",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468091361",
            "country_code": "US",
            "telephone_number": "260-478-5170",
            "fax_number": "260-478-5145",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAZOFF",
        "first_name": "SHAWN",
        "middle_name": "P.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-06",
        "last_updated": "2021-04-30",
        "certification_date": "2021-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02004719A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2020-04121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201337850",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "shawn.lazoff@lutheranhealthnetwork.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "3534 Brooklyn Ave",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468091361",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Summerfield, NC

Sources for this page

Verify at the official NPI Registry.