Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Ronald Dean Shore II, PA-C

Individual provider Physician Assistant · NPI 1083957740

Ronald Dean Shore II, PA-C is a Physician Assistant in Chicago, Illinois. Graduated from Emory University School of Medicine in 2012, 14 years ago. Practices with Charlotte Community Health Clinic, Inc, a 9-clinician group and accepts Medicare assignment. Licensed in California and Illinois.

Years since qualifying
14
Trained at
Emory University School of Medicine
Licensed in
CA, IL
In the registry since
2013
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1701 W Superior St
Chicago, IL 60622-5646
Phone: (312) 666-3494
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 56824 (CA)
Physician Assistant Taxonomy 363A00000X · Licence 085004625 (IL)

Record details

NPI number1083957740
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedApril 1, 2013
Last updated in NPPESDecember 27, 2024
Certification dateDecember 27, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolEMORY UNIVERSITY SCHOOL OF MEDICINE
Graduated 2012 (14 years in practice)
Group practice Charlotte Community Health Clinic, Inc. — 9 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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