NPIMap

Individual provider Active NPI

Jeremiah Ryan Shuck

  • Medical Physician Assistant
  • Minot, ND
National Provider Identifier
1033739925
Registry record updated Sep 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PAC0871 Issued in ND
Practice address
2305 37TH Ave SW
Minot, ND 58701-7669
Phone
(701) 857-5000
NPI assigned
Apr 21, 2020
Last updated
Sep 24, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PAC0871 ND
Medical Physician Assistant 363AM0700X PAC0871 ND Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

2305 37TH Ave SW
Minot, ND 58701-7669

Mailing address

PO Box 5010
Minot, ND 58702-5010
Phone (701) 418-8000

Other practice location 1

3251 Basswood Shores Ln NW
Miltona, MN 56354-8303
Phone (320) 760-4248

Other practice location 2

1 Burdick Expy W
Minot, ND 58701-4406
Phone (701) 857-5118

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
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
I20210420000977 ND Practitioner - Physician Assistant 1456769017 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Trinity HealthGroup PAC ID 7911816020, 292 clinicians

Practice addresses (Care Compare)

101 3Rd Ave SW
Minot, ND 58701-3880
Phone (701) 418-8000

2305 37TH Ave SW
Minot, ND 58701-7669
Phone (701) 418-8000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.05 of 100Reported as group
Quality
60.57
Promoting interoperability
98
Improvement activities
40
Cost
77.93

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PAC0871NDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Trinity Health CurrentSince Apr 8, 2021 Accepting new patients
Trinity Health CurrentSince Apr 8, 2021 Accepting new patients

Locations

2720 Dundee Rd
Northbrook, IL 60062
Phone (224) 226-5222

1 Burdick Expy W
Minot, ND 58701
Phone (701) 857-5124

101 3rd Ave SW
Minot, ND 58701
Phone (701) 857-5286

2305 37th Ave SW
Minot, ND 58701
Phone (701) 418-8550

Organizations & group practices 3

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 10

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": "1587427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758672000000",
    "number": "1033739925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5010",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587025010",
            "telephone_number": "701-418-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2305 37TH AVE SW",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587017669",
            "telephone_number": "701-857-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3251 Basswood Shores Ln NW",
            "address_purpose": "LOCATION",
            "city": "Miltona",
            "state": "MN",
            "postal_code": "563548303",
            "country_code": "US",
            "telephone_number": "320-760-4248",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Burdick Expy W",
            "address_purpose": "LOCATION",
            "city": "Minot",
            "state": "ND",
            "postal_code": "587014406",
            "country_code": "US",
            "telephone_number": "701-857-5118",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHUCK",
        "first_name": "JEREMIAH",
        "middle_name": "RYAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-21",
        "last_updated": "2025-09-24",
        "certification_date": "2025-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "PAC0871",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ND",
            "license": "PAC0871",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Minot, ND

Sources for this page

Verify at the official NPI Registry.