MR. DOUGLAS MARK SHINE (L.C.S.W.) – Clinical Social Worker, NPI 1992821201
Clinical Social Worker
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
3,374 CLINICAL SOCIAL WORKER in FL
Provider Addresses for MR. DOUGLAS MARK SHINE (L.C.S.W.)
1705 DUCK WATER CT
JACKSONVILLE, FL 322595247
Phone: (904) 287-3122
Fax: (904) 287-3122
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2017-02-15
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20170215002743 | I | Clinical Social Worker | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 90837 | Psychotherapy, 1 hour | 151 | 25 | $0 |
| 90791 | Psychiatric diagnostic evaluation | 15 | 15 | $0 |
Insurance plans in this area (ZIP 32259)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Clinical Psychologist | MD | |
| Clinical Psychologist | RI | |
| Clinical Psychologist | IL | |
| Clinical Psychologist | FL | |
| P S Y C H I A T R Y | FL | |
| Clinical Social Worker | FL | |
| P S Y C H I A T R Y | FL | |
| Clinical Psychologist | FL | |
| Nurse Practitioner | FL | |
| Clinical Social Worker | MD |
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