Active NPI
David Shrock, PA-C
- Physician Assistant
- Jackson, MS
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA00333
- Practice address
- 971 Lakeland Dr Ste 356
Jackson, MS 39216-4607 - Phone
- (601) 200-4644
- Fax
- (601) 200-4645
- NPI assigned
- Mar 24, 2016
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 1234567890 | VA | |
| Physician Assistant | 363A00000X | PA00333 | MS | Primary |
Addresses
Primary practice location
971 Lakeland Dr Ste 356
Jackson, MS 39216-4607
Mailing address
5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816-6038
Phone (601) 200-4644
Other practice location 1
1906 Belleview Ave SE
Roanoke, VA 24014-1838
Phone (540) 981-7000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
969 Lakeland Dr
Jackson, MS 39216-4606
Phone (601) 200-2000
Hospital & facility affiliations
- St Dominic-Jackson Memorial Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 89.09 of 100
- Quality
- 73.43
- Promoting interoperability
- 100
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1234567890 | VA | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| RH Hospitalist Medicine of Philadelphia LLC | Current | Accepting new patients | |
| First Intermed Corporation | Current | Accepting new patients | |
| St Dominic Medical Associates LLC | Past | Accepting new patients | |
| St. Dominic Jackson Memorial | Past | Accepting new patients |
Locations
5606 Old Canton Rd
Jackson, MS 39211
Phone (601) 924-3350
342 Gilchrist Dr
Pearl, MS 39208
Phone (601) 939-0700
1001 Holland Ave
Philadelphia, MS 39350
Phone (601) 663-1200
Organizations & group practices 5
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.
-
- Hospitalist Physician
- Jackson, MS
- NPI 1891541207
-
- Hospitalist Physician
- Philadelphia, MS
- NPI 1134083561
-
- Family Medicine Physician
- Ridgeland, MS
- NPI 1346275310
-
- Family Nurse Practitioner
- Jackson, MS
- NPI 1508263179
-
- Emergency Medicine Physician
- Jackson, MS
- NPI 1235173691
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Jackson, MS
- NPI 1306876065
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458777600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707436800000",
"number": "1104288679",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5959 S SHERWOOD FOREST BLVD",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708166038",
"telephone_number": "601-200-4644",
"fax_number": "225-765-9196"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "971 LAKELAND DR STE 356",
"city": "JACKSON",
"state": "MS",
"postal_code": "392164607",
"telephone_number": "601-200-4644",
"fax_number": "601-200-4645"
}
],
"practiceLocations": [
{
"address_1": "1906 Belleview Ave SE",
"address_purpose": "LOCATION",
"city": "Roanoke",
"state": "VA",
"postal_code": "240141838",
"country_code": "US",
"telephone_number": "540-981-7000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SHROCK",
"first_name": "DAVID",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-03-24",
"last_updated": "2024-02-09",
"certification_date": "2024-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "VA",
"license": "1234567890",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MS",
"license": "PA00333",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2024; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.