Jay Gordon Shires, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

45650 Issued in TN

Practice address

294 Summar Dr
Jackson, TN 38301-3915

Phone

(731) 423-1932

Fax

(731) 265-8355

NPI assigned

Apr 10, 2008

Last updated

Sep 9, 2020By 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 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

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.

• Shires Rehab LLC

  • Family Medicine Physician
  • Martin, TN
  • NPI 1528696473
  Authorized official Same address or phone
• Decatur County General Hospital

  • General Acute Care Hospital
  • Parsons, TN
  • NPI 1104804566
  NPD (past)
• Executive Outcomes PC

  • Internal Medicine Physician
  • Jackson, TN
  • NPI 1821352808
  NPD (past)
• Physicians Quality Care PLLC

  • Rural Health Clinic/Center
  • Milan, TN
  • NPI 1821906173
  NPD (past)

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

{
    "created_epoch": "1207785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599609600000",
    "number": "1093988008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11942",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383080132",
            "telephone_number": "731-660-2665",
            "fax_number": "731-660-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "294 SUMMAR DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013915",
            "telephone_number": "731-423-1932",
            "fax_number": "731-265-8355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIRES",
        "first_name": "JAY",
        "middle_name": "GORDON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-10",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "MD0000045650",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "45650",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1519909",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shepherd Clinical Services, LLC
• Deborah Cameron Sherer, FNP
• Mallory Kay Sherrod
• Peter Shi, D.O.
• Bayley Shields, PA-C
• Donna Shofe
• Brian Christopher Short, DDS
• George M Short, D.D.S., M.S.
• Ronald Mark Short, MD
• Holly Brooke Shourd, FNP

• Family Medicine Physician in Jackson, TN
• Providers in Jackson, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.