1. Home
  2. Directory
  3. Mississippi
  4. Jackson
  5. Anesthesiology
  6. NPI Profile

TYLER RESHADRICH-SHAURICE SHACK M.D.
NPI 1386105815
Anesthesiology in Jackson, MS

Active since March 27, 2019PECOS EnrolledAccepts Medicare Assignment
2500 N STATE ST, JACKSON, MS 39216(601) 984-5914 Get Directions Write a Review

NPPES record last updated: August 8, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Tyler Reshadrich-shaurice Shack M.d. NPPES

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

TYLER RESHADRICH-SHAURICE SHACK M.D. (NPI 1386105815) is an individual anesthesiology provider in Jackson, Mississippi, licensed in Mississippi (33326) and active in the NPI registry since March 2019. He is enrolled in Medicare PECOS and is a graduate of University Of Mississippi School Of Medicine (2019).

NPPES Registry Identity

NPI1386105815
Entity TypeIndividualMale
Primary Taxonomy207L00000X
Provider Legal NameTYLER RESHADRICH-SHAURICE SHACKCredential: M.D.
Location Address2500 N STATE STJackson, MS 39216-4500
Mailing Address2500 N State StJackson, MS 39216-4500 · (601) 984-5914
Phone(601) 984-5914
Sole ProprietorNo
Medical School CMSUniversity Of Mississippi School Of MedicineGraduated 2019
Enumeration DateMarch 27, 2019
Last NPPES UpdateAugust 8, 2025
NPPES CertifiedAugust 8, 2025
✔ NPI 1386105815 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAnesthesiologyAllopathic & Osteopathic Physicians
Taxonomy Code207L00000X
License✔ Licensed in MS · 33326
Definition
An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an operation or an obstetric or diagnostic procedure. The anesthesiologist assesses the risk of the patient undergoing surgery and optimizes the patient's condition prior to, during and after surgery. In addition to these management responsibilities, the anesthesiologist provides medical management and consultation in pain management and critical care medicine. Anesthesiologists diagnose and treat acute, long-standing and cancer pain problems; diagnose and treat patients with critical illnesses or severe injuries; direct resuscitation in the care of patients with cardiac or respiratory emergencies, including the need for artificial ventilation; and supervise post-anesthesia recovery.
2500 N STATE ST, Jackson, MS 39216
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 and accepts Medicare assignment

Tyler Reshadrich-shaurice Shack M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3173853835
PECOS Enrollment IDI20250910002118
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 Tyler Shack reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

State Of Mississippi - University Of Mississippi Medical Center
Same address
General Acute Care Hospital
2500 N STATE ST
Jackson, MS 39216
  • Reassigned Medicare billing, Mississippi enrollment
  • 1,932 clinicians in this Medicare group
NPI 1154317527 (601) 984-1000

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

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.

LAMAR DAVIS II M.D.
Psychiatry & Neurology (Neurology with Special Qualifications in Child Neurology)
2500 N STATE ST
JACKSON, MS 39216
Hinds County (601) 984-5275
STEPHEN COMMISKEY M.D.
Anesthesiology
2500 N STATE ST
JACKSON, MS 39216
Hinds County (601) 984-5900
JESSICA SAFLEY MD
Anesthesiology
2500 N STATE ST
JACKSON, MS 39216
Hinds County (601) 984-5900
DR. MARY KINNEY LOWE CORLEY MD
Obstetrics & Gynecology
2500 N STATE ST
JACKSON, MS 39216
Hinds County (601) 984-5339
LAURA ELIZABETH VEARRIER M.D.
Emergency Medicine
2500 N STATE ST
JACKSON, MS 39216
Hinds County (601) 815-2005
DR. CANDICE BRITTANY APRIL DDS
Dentist
2500 N STATE ST
JACKSON, MS 39216
Hinds County (601) 984-6028
DR. LARKIN H MITCHELL M.D.
Anesthesiology
2500 N STATE ST
JACKSON, MS 39216
Hinds County (601) 984-5900
EMILY SUMRALL CHILDRESS CRNA
Nurse Anesthetist, Certified Registered
2500 N STATE ST
JACKSON, MS 39216
Hinds County (601) 984-1000

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 Tyler Shack's NPI number?

The NPI number for Tyler Shack is 1386105815. It was assigned to this individual provider in the NPPES registry on March 27, 2019.

Where is Tyler Shack located?

Tyler Shack practices at 2500 N State St, Jackson, MS 39216. The listed phone number is (601) 984-5914.

What is Tyler Shack's specialty?

The primary specialty registered for this NPI is Anesthesiology with taxonomy code 207L00000X.

Is Tyler Shack enrolled in Medicare?

Yes. Tyler Shack is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Tyler Shack's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Tyler Shack reassigns Medicare benefits to State Of Mississippi - University Of Mississippi Medical Center (Jackson, MS). 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 Tyler Shack'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 Tyler Shack was last updated on August 8, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.