Shane Benally, OD is a medicare enrolled "Optometrist" provider in Santo Domingo Pueblo, New Mexico. He went to Southern College Of Optometry and graduated in 2022 and has 4 years of diverse experience with area of expertise as Optometry. He is a member of the group practice Kewa Pueblo Health Corporation and his current practice location is
85 W Highway 22, Santo Domingo Pueblo, New Mexico. You can reach out to his office (for appointments etc.) via phone at
(505) 465-1169.
Shane Benally is licensed to practice in Idaho (license number ODP-100585) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1588387294.
Healthcare Provider's Profile
| Full Name | Shane Benally |
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| Gender | Male |
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| Speciality | Optometry |
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| Experience | 4 Years |
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| Location | 85 W Highway 22, Santo Domingo Pueblo, New Mexico |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Shane Benally attended and graduated from Southern College Of Optometry in 2022
NPI Data:
- NPI Number: 1588387294
- Provider Enumeration Date: 09/19/2022
- Last Update Date: 07/22/2025
Medicare PECOS Information:
- PECOS PAC ID: 7810341260
- Enrollment ID: I20231004000022
Medical Identifiers
Medical identifiers for Shane Benally such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1588387294 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 152W00000X | Optometrist | ODP-100585 (Idaho) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Kewa Pueblo Health Corporation | 7618137779 | 24 |
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. Shane Benally allows following entities to bill medicare on his behalf.
| Provider Name | Dhhs Phs Ihs Phoenix Area |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1265719918
PECOS PAC ID: 2668647108
Enrollment ID: O20111212000142 |
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| Provider Name | Kewa Pueblo Health Corporation |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1467739888
PECOS PAC ID: 7618137779
Enrollment ID: O20120327000617 |
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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. Shane Benally 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 |
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Shane Benally, OD
5300 Las Soleras Dr Apt 6003,
Santa Fe, NM 87507-2002
Ph: (901) 653-5701 | Shane Benally, OD
85 W Highway 22,
Santo Domingo Pueblo, NM 87052-1283
Ph: (505) 465-1169 |
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