Scott Alan Shoup, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

4301062715 Issued in MI

Practice address

901 W Memorial Drive
Houghton, MI 49931

Phone

(904) 482-9404

Fax

(906) 483-0269

NPI assigned

Sep 6, 2006

Last updated

Jan 30, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Copper Country Community Mental Health Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Houghton, MI
  • NPI 1881607497
  NPD (past)

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391040000000",
    "number": "1013010305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 W MEMORIAL DRIVE",
            "city": "HOUGHTON",
            "state": "MI",
            "postal_code": "49931",
            "telephone_number": "904-482-9404",
            "fax_number": "906-483-0269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 W MEMORIAL DRIVE",
            "city": "HOUGHTON",
            "state": "MI",
            "postal_code": "49931",
            "telephone_number": "904-482-9404",
            "fax_number": "906-483-0269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOUP",
        "first_name": "SCOTT",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-06",
        "last_updated": "2014-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301062715",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3019786",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark Richard Shebuski, M.D.
• Michael Sheridan
• Shopko Stores Operating Co LLC (ShopKo Pharmacy 2123)
• Shopko Stores Operating Co. LLC (ShopKo Optical 123)
• Shoptikal LLC (Shopko Optical 4314)
• Candace Silvola, RPH
• Smith Holistic Care, LLC
• Heather Smith, FNP
• Jamie Lynn Smith, L.AC., NBC-HWC, LMT
• Michelle Lee Smith, LBSW

• Psychiatry Physician in Houghton, MI
• Providers in Houghton, MI by specialty
• Psychiatry Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.