Active NPI
Calvert John Shipley, M.D.
- Family Medicine Physician
- Clackamas, OR
National Provider Identifier
1023245867
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- OR MD11682
- Practice address
- 9800 SE Sunnyside Rd
Clackamas, OR 97015-9750 - Phone
- (503) 653-6440
- NPI assigned
- Jun 19, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OR MD11682 | OR | Primary |
Addresses
Primary practice location
9800 SE Sunnyside Rd
Clackamas, OR 97015-9750
Mailing address
22824 SW Lodgepole Ave
Tualatin, OR 97062-7611
Phone (503) 427-0089
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD11682 | OR | MD | Specialist |
| OR MD11682 | OR | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245369600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245369600000",
"number": "1023245867",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22824 SW LODGEPOLE AVE",
"city": "TUALATIN",
"state": "OR",
"postal_code": "970627611",
"telephone_number": "503-427-0089"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9800 SE SUNNYSIDE RD",
"city": "CLACKAMAS",
"state": "OR",
"postal_code": "970159750",
"telephone_number": "503-653-6440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIPLEY",
"first_name": "CALVERT",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-06-19",
"last_updated": "2009-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "OR MD11682",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clackamas, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.