KENNETH SHUM (DO) – Emergency Medicine Physician, NPI 1013456474

KENNETH SHUM (DO) is a healthcare provider. based in Boardman, Ohio. specializing in EMERGENCY MEDICINE. They hold the professional credentials DO. They hold a License No. 2211 (NE). The NPI Number for KENNETH SHUM (DO) is 1013456474

Main info

Male
9 Years Of Experience
Accepts Medicare Assignment
Name
KENNETH SHUM (DO)
NPI
1013456474
Phone
(330) 729-8757
Address
8401 Market St
Enumeration Date
18 February 2017
Last Update Date
10 July 2020

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4024634521
Graduation Year
2017 (9 years ago)
PAC ID
3274806252
Group Practice PAC ID
4587575550
Professional Enrollment ID
I20200713000507
Address ID
NE689014451HA715XXAVEX502
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience47
Completeness75
Years active:9State licenses:1Digital endpointsOther names

2,673 EMERGENCY MEDICINE in OH

Provider Addresses for KENNETH SHUM (DO)

  • 8401 Market St

    Boardman, OH 445126725

    Phone: (330) 729-8757

    Type: Location

  • Mary Lanning Healthcare, 715, North Saint Joseph Avenue, Countryside Parks, Hastings, Adams County, Nebraska, 68901, United States

    HASTINGS, NE 689014451

    Phone: (402) 463-4521

    Fax: (402) 460-5412

    Type: Location

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.

This can happen when there are no reportable CMS Open Payments records.

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: 2020-07-13

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20200713000507IEmergency MedicineNETBD

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.

Verify on CMS Revalidation Lookup Tool

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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99284Emergency department visit with moderate level of medical decision making180168$0
99285Emergency department visit with high level of medical decision making124115$0
99283Emergency department visit with low level of medical decision making5853$0
99282Emergency department visit with straightforward medical decision making1212$0
View full utilization report →

Insurance plans in this area (ZIP 44512)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4587575550View full group profile
NameSpecialtyState
Certified Registered Nurse Anesthetist (Crna)FL
-NE
Physician AssistantNE
Cardiovascular Disease (Cardiology)NE
Physician AssistantNE
-TN
Orthopedic SurgeryNE
Family PracticeNE
-CO
-NE

Reviews

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Frequently asked questions

Is KENNETH SHUM (DO) listed with a National Provider Identifier?
Yes — KENNETH SHUM (DO) has NPI 1013456474 on file in the registry.
Is there an active status for KENNETH SHUM (DO)?
For scheduling context, KENNETH SHUM (DO) is shown as active in the registry.
What clinical focus is listed for KENNETH SHUM (DO)?
At a glance, KENNETH SHUM (DO) is tied to Emergency Medicine Physician. Clinical services aligned with this taxonomy classification.
Is KENNETH SHUM (DO) located near Boardman?
KENNETH SHUM (DO) currently maps to Boardman, Ohio in this extract.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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