DR. JACK WILLIAM SHAW ED.D., LMHC
NPI 1124623319
Counselor - Mental Health in St Petersburg, FL

Q: What is Jack Shaw's NPI number?

The NPI number for Jack Shaw is 1124623319. It was assigned to this individual provider in the NPPES registry on December 3, 2020.

Q: What is Jack Shaw's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Q: When was this NPI record last updated?

The NPPES record for Jack Shaw was last updated on November 2, 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 December 03, 2020PECOS Enrolled

1735 DR MLK JR STREET SOUTH, ST PETERSBURG, FL 33705(727) 502-0188 Get Directions Write a Review

NPPES record last updated: November 2, 2022. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Nov 2, 2022, Dec 3, 2020 (2 updates tracked since 2020).

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About Dr. Jack William Shaw Ed.d., Lmhc NPPES

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

DR. JACK WILLIAM SHAW ED.D., LMHC (NPI 1124623319) is an individual mental health provider in St Petersburg, Florida, licensed in Florida (MH21197) and active in the NPI registry since December 2020. He is enrolled in Medicare PECOS and is a graduate of Other (2018).

NPPES Registry Identity

NPI1124623319

Entity TypeIndividualMale

Primary Taxonomy101YM0800X

Provider Legal NameDR. JACK WILLIAM SHAWCredential: ED.D., LMHC

Location Address1735 DR MLK JR STREET SOUTHSt Petersburg, FL 33705-2547

Mailing Address7780 49th St N # 254Pinellas Park, FL 33781-3440

Phone(727) 502-0188

Sole ProprietorNo

Medical School CMSOtherGraduated 2018

Enumeration DateDecember 3, 2020

Last NPPES UpdateNovember 2, 20222 updates tracked since enumeration

NPPES CertifiedOctober 31, 2022

✔ NPI 1124623319 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers

Taxonomy Code101YM0800X

License✔ Licensed in FL · MH21197

Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License MCAP100243 (FL)

1735 DR MLK JR STREET SOUTH, St Petersburg, FL 33705

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Cigna Healthcare, Cigna HealthCare of Florida, Inc., Molina Healthcare and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Jack William Shaw Ed.d., Lmhc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID6305321456

PECOS Enrollment IDI20260326003601

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.

Medicare Billing Reassignment

Medicare enrollment records show Jack Shaw reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Suncoast Center, Inc.

2.8 mi

Mental Health (Including Community Mental Health Center)

4024 CENTRAL AVE
St Petersburg, FL 33711

Reassigned Medicare billing, Florida enrollment
67 clinicians in this Medicare group

NPI 1659371763 (727) 327-7656

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Jack Shaw's NPI number?

The NPI number for Jack Shaw is 1124623319. It was assigned to this individual provider in the NPPES registry on December 3, 2020.

Where is Jack Shaw located?

Jack Shaw practices at 1735 Dr Mlk Jr Street South, St Petersburg, FL 33705. The listed phone number is (727) 502-0188.

What is Jack Shaw's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Jack Shaw enrolled in Medicare?

Yes. Jack Shaw is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jack Shaw's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jack Shaw reassigns Medicare benefits to Suncoast Center, Inc. (St Petersburg, FL). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jack Shaw's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Jack Shaw accept?

Health plans from Cigna HealthCare of Florida, Inc., Cigna Healthcare, Molina Healthcare and Oscar Health Maintenance Organization of Florida list Jack Shaw 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 Jack Shaw was last updated on November 2, 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.