NPIMap

Individual provider Active NPI

Jacob Wayne Shipley, M.D.

  • Pain Medicine Physician
  • Somerset, PA
National Provider Identifier
1063643856
Registry record updated Mar 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
License
MD450197 Issued in PA
Practice address
126 E Church St Ste 2400
Somerset, PA 15501
Phone
(814) 443-5800
Fax
(814) 443-5499
NPI assigned
Jul 28, 2009
Last updated
Mar 8, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD450197 PA
Pain Medicine (Anesthesiology) Physician 207LP2900X 35.123054 OH
Pain Medicine Physician 208VP0000X MD450197 PA Primary

Addresses

Primary practice location

126 E Church St Ste 2400
Somerset, PA 15501

Mailing address

329 S Pleasant Ave
Somerset, PA 15501-2262
Phone (814) 445-3575

Other practice location 1

7067 Tiffany Blvd Ste 230
Youngstown, OH 44514-1981
Phone (330) 758-2748

Other practice location 2

7067 Tiffany Blvd Ste 230
Youngstown, OH 44514
Phone (330) 758-2748

Other practice location 3

7067 Tiffany Blvd Ste 230
Youngstown, OH 44514
Phone (330) 758-2748

Other identifiers 8

IdentifierTypeStateIssuer
002533543OtherPAHIGHMARK BLUE SHIELD
710929OtherPAMEDICARE
CI6140OtherPARAILROAD MEDICARE
0015083500031MedicaidPA
12700751OtherOHCAQH
618271100OtherOHACS DEPT OF LABOR WC
000000873681OtherOHANTHEM BCBS
H318750OtherOHMEDICARE PTAN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jacobshipley@spm.allscriptsdirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20150713002102 PA Practitioner - Pain ManagementPractitioner - Anesthesiology 2567686355 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pain ManagementAlso: Anesthesiology
Education
Ohio State University College of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Somerset Health Services IncGroup PAC ID 2668434614, 44 clinicians
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians
Vantage Physical Therapy and Rehabilitation IncGroup PAC ID 3072424886, 253 clinicians
Mrs Physical TherapyGroup PAC ID 0042128407, 168 clinicians

Practice addresses (Care Compare)

126 E Church St
Somerset, PA 15501-2271

2000 Westinghouse Dr
Cranberry Township, PA 16066-5238

225 S Ctr Ave
Somerset, PA 15501-2033
Phone (814) 443-5845

336 Bloomfield St
Johnstown, PA 15904-3271
Phone (814) 269-2224

348 Budfield St
Johnstown, PA 15904-3214
Phone (814) 262-3950

410 Pellis Rd
Greensburg, PA 15601-4700
Phone (814) 443-5800

426 Main St
Berlin, PA 15530-1229
Phone (814) 267-4603

4538 Peach St
Erie, PA 16509-1364
Phone (814) 864-6650

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.5 of 100Reported as group
Quality
65.53
Promoting interoperability
100
Improvement activities
40
Cost
76.15

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.123054OHMDPain Medicine (Anesthesiology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Somerset Health Services Inc Current Accepting new patients
Somerset Health Services, Inc. CurrentSince Jul 1, 2015 Accepting new patients
Somerset Health Services Inc Past Accepting new patients
Windber Hospital, Inc. Anesthesiology Past Accepting new patients
Somerset Health Services Inc Past Accepting new patients
Somerset Health Services, Inc. Past Accepting new patients
Somerset Health Services, Inc. Past Accepting new patients
Somerset Health Services, Inc. Past Accepting new patients
Somerset Health Services, Inc. Pain Medicine Past Accepting new patients
Somerset Health Services, Inc. Past Accepting new patients

Locations

426 Main St
Berlin, PA 15530
Phone (814) 267-4603

126 E Church St
Ste 2400
Somerset, PA 15501
Phone (814) 443-5800

223 S Pleasant Ave
Ste 403
Somerset, PA 15501
Phone (814) 443-1028

225 S Center Ave
Somerset, PA 15501
Phone (814) 443-5000

329 S Pleasant Ave
Somerset, PA 15501
Phone (814) 445-3575

Interoperability endpoints

  • Direct secure messaging: jacob.w.shipley@upmcdirect.com

Organizations & group practices 12

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": "1248739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615161600000",
    "number": "1063643856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "329 S PLEASANT AVE",
            "city": "SOMERSET",
            "state": "PA",
            "postal_code": "155012262",
            "telephone_number": "814-445-3575",
            "fax_number": "814-445-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 E CHURCH ST STE 2400",
            "city": "SOMERSET",
            "state": "PA",
            "postal_code": "15501",
            "telephone_number": "814-443-5800",
            "fax_number": "814-443-5499"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7067 Tiffany Blvd Ste 230",
            "address_purpose": "LOCATION",
            "city": "Youngstown",
            "state": "OH",
            "postal_code": "445141981",
            "country_code": "US",
            "telephone_number": "330-758-2748",
            "fax_number": "330-758-3282",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7067 Tiffany Blvd Ste 230",
            "address_purpose": "LOCATION",
            "city": "Youngstown",
            "state": "OH",
            "postal_code": "44514",
            "country_code": "US",
            "telephone_number": "330-758-2748",
            "fax_number": "330-758-3282",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7067 Tiffany Blvd Ste 230",
            "address_purpose": "LOCATION",
            "city": "Youngstown",
            "state": "OH",
            "postal_code": "44514",
            "country_code": "US",
            "telephone_number": "330-758-2748",
            "fax_number": "330-758-3282",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIPLEY",
        "first_name": "JACOB",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-28",
        "last_updated": "2021-03-08",
        "certification_date": "2021-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "PA",
            "license": "MD450197",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "OH",
            "license": "35.123054",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "PA",
            "license": "MD450197",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "002533543",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "710929",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CI6140",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0015083500031",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12700751",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACS DEPT OF LABOR WC",
            "identifier": "618271100",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000873681",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "H318750",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jacobshipley@spm.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "126 E Church St Ste 2400",
            "city": "Somerset",
            "state": "PA",
            "country_code": "US",
            "postal_code": "15501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Somerset, PA

Sources for this page

Verify at the official NPI Registry.