EDWARD SHACKLEFORD (DO) – Emergency Medicine Physician, NPI 1790769800
Emergency Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for EDWARD SHACKLEFORD (DO)
Oak Brook Post Office, 1314, Kensington Road, Oak Brook, DuPage County, Illinois, 60523, United States
MEA AEA KENOSH SC
OAK BROOK, IL 605223043
Phone: (630) 734-0200
Fax: (630) 734-1560
Type: Mailing
Aurora Medical Center, 10400, 75th Street, Pleasant Prairie, Kenosha County, Wisconsin, 53143, United States
AURORA MEDICAL CENTER
KENOSHA, WI 531427884
Phone: (262) 697-7000
Fax: (630) 734-1560
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: 2024-09-14
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20090618000623 | I | Emergency Medicine | WI | TBD |
| I20240914000262 | I | Emergency Medicine | TX | 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 |
|---|---|---|---|---|
| 99284 | Emergency department visit with moderate level of medical decision making | 16 | 16 | $0 |
| 99285 | Emergency department visit with high level of medical decision making | 16 | 16 | $0 |
Insurance plans in this area (ZIP 60522)
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