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  7. NPI Record 1417949983

MICHAEL D SHAFFER DO
Complete NPI Record 1417949983
Family Medicine in Kerrville, TX

NPI Status: Active since August 19, 2005

Contact Information

1331 BANDERA HWY STE 4
KERRVILLE, TX
ZIP 78028
Phone: (830) 258-7762

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Middle Name
  6. Provider Credential Text
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider First Line Business Practice Location Address
  13. Provider Business Practice Location Address City Name
  14. Provider Business Practice Location Address State Name
  15. Provider Business Practice Location Address Postal Code
  16. Provider Business Practice Location Address Country Code If outside U S
  17. Provider Business Practice Location Address Telephone Number
  18. Provider Enumeration Date
  19. Last Update Date
  20. Provider Gender Code
  21. Healthcare Provider Taxonomy Code 1
  22. Provider License Number 1
  23. Provider License Number State Code 1
  24. Healthcare Provider Primary Taxonomy Switch 1
  25. Healthcare Provider Taxonomy Code 2
  26. Provider License Number 2
  27. Provider License Number State Code 2
  28. Healthcare Provider Primary Taxonomy Switch 2
  29. Healthcare Provider Taxonomy Code 3
  30. Provider License Number 3
  31. Provider License Number State Code 3
  32. Healthcare Provider Primary Taxonomy Switch 3
  33. Other Provider Identifier 1
  34. Other Provider Identifier Type Code 1
  35. Other Provider Identifier State 1
  36. Other Provider Identifier 2
  37. Other Provider Identifier Type Code 2
  38. Other Provider Identifier State 2
  39. Other Provider Identifier Issuer 2
  40. Other Provider Identifier 3
  41. Other Provider Identifier Type Code 3
  42. Other Provider Identifier State 3
  43. Other Provider Identifier Issuer 3
  44. Other Provider Identifier 4
  45. Other Provider Identifier Type Code 4
  46. Other Provider Identifier State 4
  47. Other Provider Identifier 5
  48. Other Provider Identifier Type Code 5
  49. Other Provider Identifier State 5
  50. Other Provider Identifier 6
  51. Other Provider Identifier Type Code 6
  52. Other Provider Identifier State 6
  53. Other Provider Identifier 7
  54. Other Provider Identifier Type Code 7
  55. Other Provider Identifier State 7
  56. Other Provider Identifier 8
  57. Other Provider Identifier Type Code 8
  58. Other Provider Identifier State 8
  59. Other Provider Identifier 9
  60. Other Provider Identifier Type Code 9
  61. Other Provider Identifier State 9
  62. Other Provider Identifier Issuer 9
  63. Other Provider Identifier 10
  64. Other Provider Identifier Type Code 10
  65. Other Provider Identifier State 10
  66. Other Provider Identifier 11
  67. Other Provider Identifier Type Code 11
  68. Other Provider Identifier State 11
  69. Other Provider Identifier Issuer 11
  70. Other Provider Identifier 12
  71. Other Provider Identifier Type Code 12
  72. Other Provider Identifier State 12
  73. Other Provider Identifier Issuer 12
  74. Other Provider Identifier 13
  75. Other Provider Identifier Type Code 13
  76. Other Provider Identifier State 13
  77. Other Provider Identifier Issuer 13
  78. Other Provider Identifier 14
  79. Other Provider Identifier Type Code 14
  80. Other Provider Identifier State 14
  81. Other Provider Identifier Issuer 14
  82. Other Provider Identifier 15
  83. Other Provider Identifier Type Code 15
  84. Other Provider Identifier State 15
  85. Other Provider Identifier 16
  86. Other Provider Identifier Type Code 16
  87. Other Provider Identifier State 16
  88. Other Provider Identifier Issuer 16
  89. Is Sole Proprietor
  90. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1417949983. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1417949983
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 1
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: MICHAEL
The first name of the provider, if the provider is an individual.
Provider Middle Name: D
The middle name of the provider, if the provider is an individual.
Provider Credential Text: DO
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address: 575 HILL COUNTRY DR
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: KERRVILLE
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: TX
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 780286024
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider First Line Business Practice Location Address: 1331 BANDERA HWY STE 4
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: KERRVILLE
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: TX
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 780289535
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 8302587762
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 8/19/2005
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 6/14/2023
The date that a record was last updated or changed.
Provider Gender Code: M
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 207Q00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 34-009337
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: OH
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 207QS0010X
Provider License Number 2: L6627
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 2: TX
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 207Q00000X
Provider License Number 3: L6627
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 3: TX
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 3: Y
Other Provider Identifier 1: 200036040A
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: OK
Other Provider Identifier 2: 8M0733
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: TX
Other Provider Identifier Issuer 2: HMO BLUE
Other Provider Identifier 3: 90049
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3: NM
Other Provider Identifier Issuer 3: PRESBYTERIAN COMMERCIAL
Other Provider Identifier 4: 167598501
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 4: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 4: TX
Other Provider Identifier 5: 2839254
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 5: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 5: OH
Other Provider Identifier 6: 139450100
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 6: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 6: TX
Other Provider Identifier 7: 90049
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 7: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 7: NM
Other Provider Identifier 8: 19229861
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 8: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 8: NM
Other Provider Identifier 9: P01527361
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 9: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 9: TX
Other Provider Identifier Issuer 9: RAILROAD MEDICARE
Other Provider Identifier 10: 167598506
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 10: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 10: TX
Other Provider Identifier 11: 8FE660
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 11: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 11: TX
Other Provider Identifier Issuer 11: BCBS
Other Provider Identifier 12: 8M6326
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 12: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 12: TX
Other Provider Identifier Issuer 12: BCBS
Other Provider Identifier 13: A030
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 13: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 13: NM
Other Provider Identifier Issuer 13: TRIWEST
Other Provider Identifier 14: 139450101
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 14: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 14: TX
Other Provider Identifier Issuer 14: FIRSTCARE COMMERCIAL
Other Provider Identifier 15: 167598508
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 15: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 15: TX
Other Provider Identifier 16: 8JE232
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 16: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 16: TX
Other Provider Identifier Issuer 16: BCBSTX - WCCA
Is Sole Proprietor: N
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
NPI Certification Date: 6/14/2023