Active NPI
Suzanne Marie Shepherd, MD
- Diagnostic Radiology Physician
- Little Rock, AR
National Provider Identifier
1104072974
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- CDRH.0054631
- Practice address
- 500 S University Ave Ste 101
Little Rock, AR 72205-5314 - Phone
- (501) 664-3914
- NPI assigned
- Aug 13, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | A110874 | CA | |
| Diagnostic Radiology Physician | 2085R0202X | CDRH.0054631 | CO | Primary |
Addresses
Primary practice location
500 S University Ave Ste 101
Little Rock, AR 72205-5314
Mailing address
10350 E Dakota Ave
Denver, CO 80247-1309
Other practice location 1
10350 E Dakota Ave
Denver, CO 80247-1314
Phone (303) 338-4545
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 029260 | Other | CO | KAISER COMMERCIAL NUMBER |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggateways | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100721000398 | CA | Practitioner - Diagnostic Radiology | 5193857506 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A110874 | CA | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Yampa Valley Medical Center | Current | Accepting new patients | |
| Yampa Valley Medical Center | Current | Accepting new patients | |
| Yampa Valley Medical Center | Current | Accepting new patients |
Locations
2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412
1024 Central Park Dr
Steamboat Springs, CO 80487
Phone (970) 824-1322
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 and National Provider Directory roles.
-
- Multi-Specialty Clinic/Center
- Steamboat Springs, CO
- NPI 1295177426
-
- General Acute Care Hospital
- Steamboat Springs, CO
- NPI 1790787307
-
- Pharmacy
- Steamboat Springs, CO
- NPI 1861814097
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218585600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682899200000",
"number": "1104072974",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10350 E DAKOTA AVE",
"city": "DENVER",
"state": "CO",
"postal_code": "802471309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 S UNIVERSITY AVE STE 101",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722055314",
"telephone_number": "501-664-3914"
}
],
"practiceLocations": [
{
"address_1": "10350 E Dakota Ave",
"address_purpose": "LOCATION",
"city": "Denver",
"state": "CO",
"postal_code": "802471314",
"country_code": "US",
"telephone_number": "303-338-4545",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SHEPHERD",
"first_name": "SUZANNE",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-08-13",
"last_updated": "2023-05-01",
"certification_date": "2023-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "CA",
"license": "A110874",
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "CO",
"license": "CDRH.0054631",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KAISER COMMERCIAL NUMBER",
"identifier": "029260",
"state": "CO"
}
],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggateways",
"affiliation": "N",
"endpointDescription": "Carequality",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "C-CDA",
"address_1": "10350 E Dakota Ave",
"city": "Denver",
"state": "CO",
"country_code": "US",
"postal_code": "802471314",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Little Rock, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.