EDWARD SHACKLEFORD DO
NPI 1790769800
Emergency Medicine in Kenosha, WI
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
Specialties & Licenses
Other Identifiers 3
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Edward Shackleford Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignments
2Medicare enrollment records show Edward Shackleford reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Janesville, WI 53548
- Reassigned Medicare billing, Wisconsin enrollment
- 1,155 clinicians in this Medicare group
Lawton, OK 73507
- Reassigned Medicare billing, Texas enrollment
- 347 clinicians in this Medicare group
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 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.
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
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.
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.
Which organizations bill Medicare for Edward Shackleford's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Edward Shackleford reassigns Medicare benefits to 2 organizations: Mercy Health System Corporation (Janesville, WI) and Lawton Indian Hospital (Lawton, OK). Each 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 Edward Shackleford'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 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.
# Edward Shackleford, DO · NPI 1790769800
Emergency Medicine physician in Kenosha, Wisconsin. Individual provider, active in the CMS NPPES registry since December 1, 2005.
## Identity
- **NPI:** 1790769800 (Entity type: Individual)
- **Enumerated:** December 1, 2005
- **Primary specialty:** Emergency Medicine · taxonomy 207P00000X
- **State license:** 42953021 (Wisconsin)
- **Sole proprietor:** No
## Practice location
- **Address:** 10400 75TH ST, AURORA MEDICAL CENTER, Kenosha, WI 53142-7884
- **Phone:** (262) 697-7000 · **Fax:** (630) 734-1560
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Mercy Health System Corporation (NPI 1669685129, Janesville, WI); Lawton Indian Hospital (NPI 1760489223, Lawton, OK) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 8, 2007
- **Other identifiers:** Medicare ID-Type Unspecified 0003 (WI); Medicare UPIN G25261; Medicaid 30099700 (WI)
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Source: [NPI Profile](https://npiprofile.com/npi/1790769800) · Data from the CMS NPPES public registry.