Edward Shackleford, DO in Kenosha, WI - Medicare Emergency Medicine

Edward Shackleford, DO is a medicare enrolled "Emergency Medicine" physician in Kenosha, Wisconsin. His current practice location is 10400 75th St, Aurora Medical Center, Kenosha, Wisconsin. You can reach out to his office (for appointments etc.) via phone at (262) 697-7000.

Edward Shackleford is licensed to practice in Wisconsin (license number 42953021) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1790769800.

Contact Information

	Edward Shackleford, DO
	10400 75th St, Aurora Medical Center, Kenosha, WI 53142-7884
	(262) 697-7000
	(630) 734-1560

Map and Direction

Physician's Profile

Full Name	Edward Shackleford
Gender	Male
Speciality	Emergency Medicine
Location	10400 75th St, Kenosha, Wisconsin
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1790769800
Provider Enumeration Date: 12/01/2005
Last Update Date: 07/08/2007

Medicare PECOS Information:

PECOS PAC ID: 6608926399
Enrollment ID: I20090618000623

Medical Identifiers

Medical identifiers for Edward Shackleford such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1790769800	NPI	-	NPPES
30099700	Medicaid	WI

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207P00000X	Emergency Medicine	42953021 (Wisconsin)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Edward Shackleford allows following entities to bill medicare on his behalf.

Entity Name	Mercy Health System Corporation
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1598718603 PECOS PAC ID: 7416860440 Enrollment ID: O20031113000164

Entity Name	Aspirus Riverview Hospital & Clinics Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1295754844 PECOS PAC ID: 4587658182 Enrollment ID: O20040414000945

Entity Name	Ihc-st Nicholas Emergency Physicians, Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1245288836 PECOS PAC ID: 2264403021 Enrollment ID: O20040804001040

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Edward Shackleford is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Edward Shackleford, DO Po Box 3043, Mea Aea Kenosh Sc, Oak Brook, IL 60522-3043 Ph: (630) 734-0200	Edward Shackleford, DO 10400 75th St, Aurora Medical Center, Kenosha, WI 53142-7884 Ph: (262) 697-7000

Reviews and Comments

Emergency Medicine Doctors in Kenosha, WI

David Eric Farkas, MD Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 10400 75th St, Aurora Medical Center, Kenosha, WI 53142 Phone: 262-697-7000 Fax: 630-734-1560
Ms. Kimberly Roberson, PA Emergency Medicine Medicare: Medicare Enrolled Practice Location: 10400 75th St, Kenosha, WI 53142 Phone: 262-948-5600
Terry Zehr, MD Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 10400 75th St, Kenosha, WI 53142 Phone: 262-948-7000
Manuel A. Rivera, M.D. Emergency Medicine Medicare: May Accept Medicare Assignments Practice Location: 4536 22nd Ave, Kenosha, WI 53140 Phone: 262-656-0044 Fax: 262-653-2218
Mounica D Robinson, M.D. Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 10400 75th St, Kenosha, WI 53142 Phone: 262-948-5600
Benjamin A Feinzimer, D.O. Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 6308 8th Ave, Kenosha, WI 53143 Phone: 414-290-6720 Fax: 414-290-6755
Therese Marie Whitt, MD Emergency Medicine Medicare: Medicare Enrolled Practice Location: 10400 75th St, Aurora Medical Center, Kenosha, WI 53142 Phone: 262-697-7000 Fax: 630-734-1560

Edward Shackleford, DO - Medicare Emergency Medicine in Kenosha, WI