Grover Gene Shipman, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

MD25595 Issued in OR

Practice address

914 Pine Street
Mount Shasta, CA 96067-2143

Phone

(530) 926-6111

NPI assigned

Sep 6, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Mount Eddy Emergency Physicians Medical Group, Inc.

  • Emergency Medicine Physician
  • Mount Shasta, CA
  • NPI 1316299787

  CA, Emergency Medicine

  Medicare reassignment NPD
• Siskiyou Hospital, Inc.

  • Critical Access Hospital
  • Yreka, CA
  • NPI 1093892275

  CA

  Medicare reassignment NPD
• Valley Emergency Physicians Medical Group, Inc

  • Emergency Medicine Physician
  • Mount Shasta, CA
  • NPI 1497849574

  Emergency Medicine

  NPD (past)

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214956800000",
    "number": "1104929017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 12259",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926852259",
            "telephone_number": "888-634-8405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 PINE STREET",
            "city": "MOUNT SHASTA",
            "state": "CA",
            "postal_code": "960672143",
            "telephone_number": "530-926-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIPMAN",
        "first_name": "GROVER",
        "middle_name": "GENE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-06",
        "last_updated": "2008-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OR",
            "license": "MD25595",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A967380",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shasta Midwives Birth Center Inc
• Shasta Mountain Shuttle and Tours LLC
• Shasta Vision Group an Optometric Corporation
• Kevin Shearer, D.D.S.
• L. Richard Shearer, M.D.
• Anca Marissa Sira, L.AC, FABORM
• Siskiyou Union High School District
• Siskiyou Wellness Community Mental Health
• Nathan Sivananda, D.C.
• Kelsey Sloat

• All providers in Mount Shasta, CA
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2008; 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.

Verify at the official NPI Registry.