Active NPI
Loni Lynn Shepherd, MD
- Pediatrics Physician
- Lake Jackson, TX
National Provider Identifier
1073704268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- BP1-0029096
- Practice address
- 208 Oak Dr S
Suite 400
Lake Jackson, TX 77566-5790 - Phone
- (979) 285-2900
- Fax
- (979) 285-2904
- NPI assigned
- Aug 5, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | BP1-0029096 | TX | Primary |
Addresses
Primary practice location
208 Oak Dr S
Suite 400
Lake Jackson, TX 77566-5790
Mailing address
208 Oak Dr S
Suite 400
Lake Jackson, TX 77566-5790
Phone (979) 285-2900
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 214871001 | Medicaid | TX | |
| 4644840750 | Other | MYUTMB 4644840750 |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BP1-0029096 | TX | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shepherds Pediatric Care | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Primary Care Clinic/Center
- Lake Jackson, TX
- NPI 1790108454
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1291680000000",
"number": "1073704268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "208 OAK DR S",
"address_2": "SUITE 400",
"city": "LAKE JACKSON",
"state": "TX",
"postal_code": "775665790",
"telephone_number": "979-285-2900",
"fax_number": "979-285-2904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "208 OAK DR S",
"address_2": "SUITE 400",
"city": "LAKE JACKSON",
"state": "TX",
"postal_code": "775665790",
"telephone_number": "979-285-2900",
"fax_number": "979-285-2904"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEPHERD",
"first_name": "LONI",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-08-05",
"last_updated": "2010-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "BP1-0029096",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "214871001",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MYUTMB 4644840750",
"identifier": "4644840750",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Jackson, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.