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STAG BLAIR SHADDUCK
NPI 1962093674
Physician Assistant in Edgewood, KY

Active since January 27, 2021PECOS EnrolledAccepts Medicare Assignment
90.38/100
CMS Quality Rating
560 S LOOP RD, EDGEWOOD, KY 41017(859) 301-2663(859) 817-7848 Get Directions Write a Review

NPPES record last updated: August 18, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Aug 18, 2021, Jan 27, 2021 (2 updates tracked since 2021).

About Stag Blair Shadduck NPPES

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

STAG BLAIR SHADDUCK (NPI 1962093674) is an individual physician assistant in Edgewood, Kentucky, licensed in Kentucky (TC072) and active in the NPI registry since January 2021. He is enrolled in Medicare PECOS, is affiliated with St Elizabeth Edgewood, and is a graduate of Other (2021).

NPPES Registry Identity

NPI1962093674
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameSTAG BLAIR SHADDUCK
Location Address560 S LOOP RDEdgewood, KY 41017-3405
Mailing Address560 S Loop RdEdgewood, KY 41017-3405 · (859) 301-2663 · Fax (859) 817-7848
Phone(859) 301-2663
Fax(859) 817-7848
Sole ProprietorYes
Medical School CMSOtherGraduated 2021
Enumeration DateJanuary 27, 2021
Last NPPES UpdateAugust 18, 20212 updates tracked since enumeration
NPPES CertifiedAugust 18, 2021
✔ NPI 1962093674 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in KY · TC072
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
560 S LOOP RD, Edgewood, KY 41017
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Home State Health, Ambetter from Meridian and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Stag Blair Shadduck 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 ID143625368
PECOS Enrollment IDI20210825002564
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.

Areas of Expertise CMS Part B claims 7

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
52 services51 patients
Treatment of broken neck of thigh bone with bone implant 27245
This procedure involves repairing a fractured thigh bone by inserting a bone implant. The implant helps stabilize the bone, allowing it to heal correctly. It's performed under anesthesia and requires a hospital stay for recovery.
40 services38 patients
X-ray of ankle, minimum of 3 views 73610
An ankle X-ray is a quick, painless imaging test. It involves capturing at least three different images or 'views' of your ankle using small amounts of radiation. These images help identify any abnormalities or injuries, such as fractures or arthritis.
36 services27 patients
X-ray of foot, minimum of 3 views 73630
An X-ray of the foot, minimum of 3 views, is a non-invasive imaging test. It uses a small amount of radiation to produce images of the bones and tissues in your foot. This helps to identify fractures, infections, or other abnormalities. Multiple views ensure a comprehensive examination.
25 services18 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
23 services23 patients
X-ray of thigh bone, minimum 2 views 73552
An X-ray of the thigh bone is a non-invasive imaging test. It involves passing a small amount of radiation through the thigh to produce images of the bone structure. At least two different angles are captured for a comprehensive view. This helps detect fractures, infections, or other abnormalities.
19 services17 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

St Elizabeth Edgewood

Acute Care Hospitals · Edgewood, KY
5/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number180035
Location1 Medical Village DriveEdgewood, KY 41017 · Kenton County
Emergency services Birthing friendly

St Elizabeth Florence

Acute Care Hospitals · Florence, KY
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number180045
Location4900 Houston RoadFlorence, KY 41042 · Boone County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 41017 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
$82.24 typical visit price
range $52.76 – $162.27
Typical copayment $20.56 (range $13.19 – $40.56)
Most-billed visit code 99203
Established Patient
$66.24 typical visit price
range $16.53 – $131.99
Typical copayment $16.56 (range $4.13 – $32.99)
Most-billed visit code 99213
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.

90.38/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality80.76
Promoting Interoperability100
Improvement Activities40

Referred Medical Equipment & Supplies CMS DME claims

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf L4361
DME-Orthotic Devices · category DF003N
1 supplier25 claims25 services$227.73 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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. MATTHEW JAMES CONNOLLY D.P.M.
Podiatrist
560 S LOOP RD
EDGEWOOD, KY 41017
Kenton County (859) 301-2663
MR. SPENCER HERBERT COLE MPAS, PA-C
Physician Assistant
560 S LOOP RD
EDGEWOOD, KY 41017
Kenton County (859) 301-2663
ORTHOCINCY ORTHOPAEDICS & SPORTS MEDICINE
Orthopaedic Surgery (Sports Medicine)
560 S LOOP RD
EDGEWOOD, KY 41017
Kenton County (859) 817-7500
GAITWELL ORTHOTICS AND PEDORTHICS
Orthotist
560 S LOOP RD
EDGEWOOD, KY 41017
Kenton County (859) 301-0622
CATHERINE KREMER PA-C
Physician Assistant
560 S LOOP RD
EDGEWOOD, KY 41017
Kenton County (859) 301-2663
MR. MATTHEW GIESE PA-C
Physician Assistant (Surgical)
560 S LOOP RD
EDGEWOOD, KY 41017
Kenton County (859) 301-2663
MR. BRANDON PATRICK GRIFFIN D.P.T.
Physical Therapist
560 S LOOP RD
EDGEWOOD, KY 41017
Kenton County (859) 301-2663
ADAM PHILLIP SCHUMAIER MD
Orthopaedic Surgery
560 S LOOP RD
EDGEWOOD, KY 41017
Kenton County (859) 817-3599

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 Stag Shadduck's NPI number?

The NPI number for Stag Shadduck is 1962093674. It was assigned to this individual provider in the NPPES registry on January 27, 2021.

Where is Stag Shadduck located?

Stag Shadduck practices at 560 S Loop Rd, Edgewood, KY 41017. The listed phone number is (859) 301-2663.

What is Stag Shadduck's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Stag Shadduck enrolled in Medicare?

Yes. Stag Shadduck 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.

What insurance does Stag Shadduck accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Home State Health, Ambetter from Meridian and Ambetter of Tennessee and 2 other insurers list Stag Shadduck as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Stag Shadduck affiliated with any hospitals?

According to CMS data, Stag Shadduck is affiliated with St Elizabeth Edgewood and St Elizabeth Florence.

When was this NPI record last updated?

The NPPES record for Stag Shadduck was last updated on August 18, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.