KRISTIAN TAYLOR SHAW (PA-C) – Medical Physician Assistant, NPI 1477112381
Medical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
5,035 PHYSICIAN ASSISTANT in IL
Provider Addresses for KRISTIAN TAYLOR SHAW (PA-C)
828 Waterford Cut
Crystal Lake, IL 600148506
Phone: (847) 306-9843
Type: Location
828, Waterford Cut, Crystal Lake, McHenry County, Illinois, 60014, United States
CRYSTAL LAKE, IL 600148506
Phone: (847) 306-9843
Type: Location
14601 DETROIT AVE
LAKEWOOD, OH 441074205
Phone: (216) 237-5500
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 11 Open Payments records for all available years, with a total value of $863.
Total Amount is formed as General ($863) + Research ($0) + Ownership ($0) = $863.
Last reported payment date: 2024-11-15 • Largest payer in this snapshot: Dermavant Sciences, Inc. ($208).
Total Amount
$863
General + Research + Ownership
Payments
11
Total payment records
General Amount
$863
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-15
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Dermavant Sciences, Inc. | $208 |
| SUN PHARMACEUTICAL INDUSTRIES INC. | $131 |
| E.R. Squibb & Sons, L.L.C. | $130 |
| Gilead Sciences, Inc. | $121 |
| ABBVIE INC. | $106 |
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: 2023-07-27
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 |
|---|---|---|---|---|
| I20230727002682 | I | Physician Assistant | OH | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 60014)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | NV | |
| Nephrology, Internal Medicine | OH | |
| - | OH | |
| - | MI | |
| Nurse Practitioner | OH | |
| General Surgery, Anesthesiology, Critical Care (Intensivists) | OH | |
| Certified Registered Nurse Anesthetist (Crna) | OH | |
| - | OH | |
| - | MN | |
| Nurse Practitioner | OH |
Reviews
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