NPIMap

Individual provider Active NPI

James White Shepherd III, MD

  • Family Medicine Physician
  • Harwich, MA
National Provider Identifier
1003823295
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
209452 Issued in MA
Practice address
253 Pleasant Lake Ave
Harwich, MA 02645-2535
Phone
(508) 432-5233
Fax
(508) 430-0511
NPI assigned
Aug 1, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 209452 MA Primary

Addresses

Primary practice location

253 Pleasant Lake Ave
Harwich, MA 02645-2535

Mailing address

253 Pleasant Lake Ave
Harwich, MA 02645-2535
Phone (508) 432-5233

Other identifiers 3

IdentifierTypeStateIssuer
0148521MedicaidMA
J24110OtherMABCBS
711548OtherMAHARVARD PILGRIM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100805000695 MA Practitioner - Family Practice 5193858587 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Iowa, RJ & L Carver College of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pleasant Lake Medical Center LLCGroup PAC ID 1951741057, 5 clinicians
Physiotherapy Associates IncGroup PAC ID 3577470442, 1,432 clinicians

Practice addresses (Care Compare)

253 Pleasant Lake Ave
Suite 100
Harwich, MA 02645-2552
Phone (617) 785-2066

860 Route 134
Suite 5And6
South Dennis, MA 02660-2577
Phone (508) 385-4212

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
209452MAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pleasant Lake Medical Center LLC CurrentSince Apr 7, 2024 Accepting new patients

Locations

253 Pleasant Lake Ave
Ste 100
Harwich, MA 02645
Phone (508) 432-5233

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EIICDD/Endpoint/EIICDD

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003823295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "253 PLEASANT LAKE AVE",
            "city": "HARWICH",
            "state": "MA",
            "postal_code": "026452535",
            "telephone_number": "508-432-5233",
            "fax_number": "508-430-0511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "253 PLEASANT LAKE AVE",
            "city": "HARWICH",
            "state": "MA",
            "postal_code": "026452535",
            "telephone_number": "508-432-5233",
            "fax_number": "508-430-0511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEPHERD",
        "first_name": "JAMES",
        "middle_name": "WHITE",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "209452",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0148521",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "J24110",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "711548",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Harwich, MA

Sources for this page

Verify at the official NPI Registry.