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EDWARD SHACKLEFORD DO
NPI 1790769800
Emergency Medicine in Kenosha, WI

Active since December 01, 2005PECOS Enrolled
10400 75TH ST, AURORA MEDICAL CENTER, KENOSHA, WI 53142(262) 697-7000(630) 734-1560 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Edward Shackleford Do NPPES

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

EDWARD SHACKLEFORD DO (NPI 1790769800) is an individual emergency medicine provider in Kenosha, Wisconsin, licensed in Wisconsin (42953021) and active in the NPI registry since December 2005. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1790769800
Entity TypeIndividualMale
Primary Taxonomy207P00000X
Provider Legal NameEDWARD SHACKLEFORDCredential: DO
Location Address10400 75TH ST, AURORA MEDICAL CENTERKenosha, WI 53142-7884
Mailing AddressPo Box 3043, Mea Aea Kenosh ScOak Brook, IL 60522-3043 · (630) 734-0200 · Fax (630) 734-1560
Phone(262) 697-7000
Fax(630) 734-1560
Sole ProprietorNo
Enumeration DateDecember 1, 2005
Last NPPES UpdateJuly 8, 2007
✔ NPI 1790769800 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyEmergency MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207P00000X
License✔ Licensed in WI · 42953021
Definition
An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.
10400 75TH ST, Kenosha, WI 53142
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Other Identifiers 3

Medicare ID-Type Unspecified0003WI
Medicare UPING25261
Medicaid30099700WI

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Edward Shackleford Do 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 53142 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
$82.92 typical visit price
range $53.90 – $163.24
Typical copayment $20.73 (range $13.47 – $40.81)
Most-billed visit code 99203
Established Patient
$95.41 typical visit price
range $17.40 – $133.76
Typical copayment $23.85 (range $4.35 – $33.44)
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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

Reported Quality Measures

Documentation of Current Medications in the Medical Record
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter.
100%163 patients5/55-star benchmark: 100%
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

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.

DR. UZMA REZVI M. D.
Anesthesiology
10400 75TH ST
KENOSHA, WI 53142
Kenosha County (262) 948-5600
DAVID B KITE PA
Physician Assistant
10400 75TH ST
KENOSHA, WI 53142
Kenosha County (262) 948-7000
MRS. SUSAN H. PERGANDE WHNP
Nurse Practitioner (Women's Health)
10400 75TH ST
KENOSHA, WI 53142
Kenosha County (262) 948-6714
DAVID ERIC FARKAS MD
Emergency Medicine
10400 75TH ST, AURORA MEDICAL CENTER
KENOSHA, WI 53142
Kenosha County (262) 697-7000
PAULA MICHELLE OSGOOD CRNA
Nurse Anesthetist, Certified Registered
10400 75TH ST
KENOSHA, WI 53142
Kenosha County (262) 948-5600
DOROTHY KATHERINE FREE
Nurse Anesthetist, Certified Registered
10400 75TH ST
KENOSHA, WI 53142
Kenosha County (262) 948-5600
ZEBI FATIMA MD
Internal Medicine
10400 75TH ST
KENOSHA, WI 53142
Kenosha County (262) 942-5600
JENNIFER J JOHNSON RN
Registered Nurse (Critical Care Medicine)
10400 75TH ST
KENOSHA, WI 53142
Kenosha County (262) 948-5730

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 Edward Shackleford's NPI number?

The NPI number for Edward Shackleford is 1790769800. It was assigned to this individual provider in the NPPES registry on December 1, 2005.

Where is Edward Shackleford located?

Edward Shackleford practices at 10400 75th St Aurora Medical Center, Kenosha, WI 53142. The listed phone number is (262) 697-7000.

What is Edward Shackleford's specialty?

The primary specialty registered for this NPI is Emergency Medicine with taxonomy code 207P00000X.

Is Edward Shackleford enrolled in Medicare?

Yes. Edward Shackleford is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Edward Shackleford was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.