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

Q: 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.

Q: What is Colleen Shackelford's specialty?

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

Active since August 31, 2011PECOS Enrolled

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: October 04, 2026.

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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 is enrolled in Medicare PECOS.

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

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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

✔

Enrolled in Medicare (PECOS)

Mrs. Colleen M Shackelford Np 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.

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