1. Home
  2. Directory
  3. Michigan
  4. Saint Clair Shores
  5. Nurse Practitioner
  6. NPI Profile
Newly Listed Provider — this NPI profile has been added to the NPI registry within the last 90 days.

KRYSTAL ROSE SHOCK
NPI 1255254819
Nurse Practitioner - Family in Saint Clair Shores, MI

Active since July 31, 2026PECOS Enrolled
22631 GREATER MACK AVE STE 100, SAINT CLAIR SHORES, MI 48080(586) 800-0086(586) 800-0087 Get Directions Write a Review

NPPES record added: July 31, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Krystal Rose Shock NPPES

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

KRYSTAL ROSE SHOCK (NPI 1255254819) is an individual family provider in Saint Clair Shores, Michigan, licensed in Michigan (4704381967) and active in the NPI registry since July 2026. She is enrolled in Medicare PECOS and is a graduate of Other (2026).

NPPES Registry Identity

NPI1255254819
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameKRYSTAL ROSE SHOCK
Location Address22631 GREATER MACK AVE STE 100Saint Clair Shores, MI 48080-2055
Mailing AddressPo Box 4236Southfield, MI 48037-4236
Phone(586) 800-0086
Fax(586) 800-0087
Sole ProprietorYes
Medical School CMSOtherGraduated 2026
Enumeration DateJuly 31, 2026
NPPES CertifiedJuly 31, 2026
✔ NPI 1255254819 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in MI · 4704381967
22631 GREATER MACK AVE STE 100, Saint Clair Shores, MI 48080
Open in Google Maps ↗

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Krystal Rose Shock is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID4385104041
PECOS Enrollment IDI20260902001897
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 Krystal Shock reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Amine P Amine MD PC
Same address
Adolescent Medicine
22631 GREATER MACK AVE STE 100
Saint Clair Shores, MI 48080
  • Reassigned Medicare billing, Michigan enrollment
  • 5 clinicians in this Medicare group
NPI 1376296434 (586) 800-0086

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 48080 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
$90.76 typical visit price
range $58.04 – $177.36
Typical copayment $22.69 (range $14.51 – $44.34)
Most-billed visit code 99203
Established Patient
$102.35 typical visit price
range $18.32 – $143.49
Typical copayment $25.58 (range $4.58 – $35.87)
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 3

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

AMINE P AMINE MD PC
Internal Medicine (Adolescent Medicine)
22631 GREATER MACK AVE STE 100
SAINT CLAIR SHORES, MI 48080
Macomb County (586) 800-0086
BETA MEDICAL PRACTICE PLLC
Internal Medicine (Nephrology)
22631 GREATER MACK AVE STE 100
SAINT CLAIR SHORES, MI 48080
Macomb County (248) 331-5158
KATHLEEN DOBBS FNP-BC
Nurse Practitioner (Family)
22631 GREATER MACK AVE STE 100
SAINT CLAIR SHORES, MI 48080
Macomb County (586) 800-0086

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 Krystal Shock's NPI number?

The NPI number for Krystal Shock is 1255254819. It was assigned to this individual provider in the NPPES registry on July 31, 2026.

Where is Krystal Shock located?

Krystal Shock practices at 22631 Greater Mack Ave Ste 100, Saint Clair Shores, MI 48080. The listed phone number is (586) 800-0086.

What is Krystal Shock's specialty?

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

Is Krystal Shock enrolled in Medicare?

Yes. Krystal Shock is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Krystal Shock's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Krystal Shock reassigns Medicare benefits to Amine P Amine MD PC (Saint Clair Shores, MI). 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 Krystal Shock's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Krystal Shock was last updated on July 31, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months 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.