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MRS. COLLEEN M SHACKELFORD NP
NPI 1104107317
Nurse Practitioner - Family in Boise, ID

Active since August 31, 2011Opted out of Medicare · through Oct 1, 2026
300 E BANNOCK ST, BOISE, ID 83712(208) 342-7400(208) 342-1879 Get Directions Write a Review

NPPES record last updated: October 4, 2018. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Mrs. Colleen M Shackelford Np NPPES

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

MRS. COLLEEN M SHACKELFORD NP (NPI 1104107317) is an individual family provider in Boise, Idaho, licensed in Idaho (NP1127A) and active in the NPI registry since August 2011. She has opted out of Medicare through October 1, 2026 and remains eligible to order and refer.

NPPES Registry Identity

NPI1104107317
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameMRS. COLLEEN M SHACKELFORDCredential: NP
Location Address300 E BANNOCK STBoise, ID 83712-6207
Mailing Address300 E Bannock StBoise, ID 83712-6207 · (208) 342-7400 · Fax (208) 342-1879
Phone(208) 342-7400
Fax(208) 342-1879
Sole ProprietorNo
Enumeration DateAugust 31, 2011
Last NPPES UpdateOctober 4, 2018
✔ NPI 1104107317 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
Licenses✔ Licensed in ID · NP1127A✔ Licensed in ID · NP-1127A
Also ListedRegistered NurseTaxonomy 163W00000X · License N-41423 (ID)
300 E BANNOCK ST, Boise, ID 83712
Open in Google Maps ↗

Other Names 1

Former Name (1)Colleen Marie Bender Rn

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc., PacificSource Health Plans.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Mrs. Colleen M Shackelford Np has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from October 1, 2016 through October 1, 2026.

Opt-Out Effective DateOctober 1, 2016
Opt-Out In Effect ThroughOctober 1, 2026Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 83712 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$81.13 typical visit price
range $52.44 – $160.17
Typical copayment $20.28 (range $13.11 – $40.04)
Most-billed visit code 99203
Established Patient
$93.26 typical visit price
range $16.68 – $130.93
Typical copayment $23.31 (range $4.17 – $32.73)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 7

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

DR. JOHN J ECK M.D.
Family Medicine
300 E BANNOCK ST
BOISE, ID 83712
Ada County (208) 342-7400
DR. DAVID L GEE MD
Family Medicine
300 E BANNOCK ST
BOISE, ID 83712
Ada County (208) 342-7400
JON L HLAVINKA M.D.
Family Medicine
300 E BANNOCK ST
BOISE, ID 83712
Ada County (208) 342-7400
EVOLVE OBGYN, PLLC
Obstetrics & Gynecology
300 E BANNOCK ST
BOISE, ID 83712
Ada County (208) 261-1380
SHELBY SHANABERGER RD
Dietitian, Registered
300 E BANNOCK ST
BOISE, ID 83712
Ada County (208) 342-1664
CENTER FOR LIFETIME HEALTH
Family Medicine
300 E BANNOCK ST
BOISE, ID 83712
Ada County (208) 342-7400
BREA L SHRUM MD
Obstetrics & Gynecology
300 E BANNOCK ST
BOISE, ID 83712
Ada County (208) 261-1380

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Colleen Shackelford's NPI number?

The NPI number for Colleen Shackelford is 1104107317. It was assigned to this individual provider in the NPPES registry on August 31, 2011. The provider is also known as Colleen Marie Bender Rn.

Where is Colleen Shackelford located?

Colleen Shackelford practices at 300 E Bannock St, Boise, ID 83712. The listed phone number is (208) 342-7400.

What is Colleen Shackelford's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Colleen Shackelford enrolled in Medicare?

No. Colleen Shackelford has opted out of Medicare through October 1, 2026. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

What insurance does Colleen Shackelford accept?

Health plans from Moda Health Plan, Inc. and PacificSource Health Plans list Colleen Shackelford as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Colleen Shackelford was last updated on October 4, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.