Organization Active NPI

Cornerstone Medical, LLC

  • Internal Medicine Physician
  • Joplin, MO
National Provider Identifier
1104549948
Registry record updated Sep 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CORNERSTONE MEDICAL, LLC
Practice address
2613 S Main St Ste D
Joplin, MO 64804-2678
Phone
(417) 624-8730
NPI assigned
Sep 26, 2022
Last updated
Sep 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2025

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

Authorized official

Name
Joseph Kirk SheppardNPI 1083901821
Title
Ceo
Phone
(417) 379-1176

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Obesity Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RB0002X
Facial Plastic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207YS0123X
Otolaryngic Allergy PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207YX0602X

Addresses

Primary practice location

2613 S Main St Ste D
Joplin, MO 64804-2678

Mailing address

2613 S Main St Ste D
Joplin, MO 64804-2678
Phone (417) 553-7920

Other practice location 1

308 N Main St
Granby, MO 64844-8357
Phone (417) 553-7920

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221018001701 MO Part B Supplier - Clinic/Group Practice 4284000183 Receives reassigned benefits from 9 practitioners
Practice locations: Granby, MO; Joplin, MO

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D2308989Cornerstone Medical LLC308 N Main St, Granby, MO 64844Certificate of waiverAug 6, 2026

National Provider Directory

National Provider Directory

Locations

308 N Main St
Granby, MO 64844
Phone (417) 553-7920

2613 S Main St
Ste D
Joplin, MO 64804
Phone (417) 553-7920

2702 Cunningham Ave
Joplin, MO 64804

2702 Cunningham Ave
Ste A
Joplin, MO 64804
Phone (417) 553-7920

Practitioners & affiliated clinicians

Practitioners 45

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1664150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758758400000",
    "number": "1104549948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2613 S MAIN ST STE D",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648042678",
            "telephone_number": "417-553-7920",
            "fax_number": "877-464-5922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2613 S MAIN ST STE D",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648042678",
            "telephone_number": "417-624-8730"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "308 N Main St",
            "address_purpose": "LOCATION",
            "city": "Granby",
            "state": "MO",
            "postal_code": "648448357",
            "country_code": "US",
            "telephone_number": "417-553-7920",
            "fax_number": "877-464-5922",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CORNERSTONE MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-26",
        "last_updated": "2025-09-25",
        "certification_date": "2025-09-25",
        "status": "A",
        "authorized_official_last_name": "SHEPPARD",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "KIRK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "417-379-1176"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RB0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Obesity Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207YS0123X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207YX0602X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Otolaryngic Allergy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Joplin, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.