COLLIE MASON SHAW
NPI 1013658111
Student in an Organized Health Care Education/Training Program in Searcy, AR

Q: What is Collie Shaw's NPI number?

The NPI number for Collie Shaw is 1013658111. It was assigned to this individual provider in the NPPES registry on April 5, 2022.

Q: What is Collie Shaw's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Collie Shaw was last updated on April 5, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 05, 2022PECOS Enrolled

3214 E RACE AVE, SEARCY, AR 72143(501) 380-2280(501) 380-2282 Get Directions Write a Review

NPPES record last updated: April 5, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Collie Mason Shaw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

COLLIE MASON SHAW (NPI 1013658111) is an individual student in an organized health care education/training program in Searcy, Arkansas and active in the NPI registry since April 2022. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1013658111

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameCOLLIE MASON SHAW

Location Address3214 E RACE AVESearcy, AR 72143-4810

Mailing Address3214 E Race AveSearcy, AR 72143-4810 · (501) 380-2280 · Fax (501) 380-2282

Phone(501) 380-2280

Fax(501) 380-2282

Sole ProprietorNo

Enumeration DateApril 5, 2022

NPPES CertifiedApril 4, 2022

✔ NPI 1013658111 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

3214 E RACE AVE, Searcy, AR 72143

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Collie Mason Shaw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. CALEB JARRED CONRAD DO

Student in an Organized Health Care Education/Training Program