NPIMap

Individual provider Active NPI

Jacqueline R Shipman, PA-C

  • Physician Assistant
  • Elkins, WV
National Provider Identifier
1154779213
Registry record updated May 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
812 Issued in WV
Practice address
812 Gorman Ave
Elkins, WV 26241-3181
Phone
(304) 636-3300
Fax
(304) 637-3441
NPI assigned
May 31, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 812 WV
Physician Assistant 363A00000X 812 WV Primary

Addresses

Primary practice location

812 Gorman Ave
Elkins, WV 26241-3181

Mailing address

812 Gorman Ave
Elkins, WV 26241-3181
Phone (304) 636-3300

Other names 1

  • Jacqueline R Shipman-Cespedes Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040707000747 WV Practitioner - Physician Assistant 2365429313 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
United Hospital Center IncGroup PAC ID 8123936010, 290 clinicians
Davis Memorial HospitalGroup PAC ID 3072418540, 77 clinicians

Practice addresses (Care Compare)

527 Medical Park Dr
Suite 402
Bridgeport, WV 26330-9010
Phone (681) 342-3690

812 Gorman Ave
Elkins, WV 26241-3181
Phone (304) 636-3366

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
812WVMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
United Hospital Center, Inc. CurrentSince Nov 3, 2025 Accepting new patients
Monongalia County General Hospital Company CurrentSince Jul 31, 2023 Accepting new patients
Davis Memorial Hospital CurrentSince Jun 20, 2016 Accepting new patients
United Hospital Center Past Accepting new patients

Locations

527 Medical Park Dr
Ste 402
Bridgeport, WV 26330
Phone (681) 342-3690

327 Medical Park Dr
Bridgeport, WV 26330
Phone (681) 342-1000

812 Gorman Ave
Elkins, WV 26241
Phone (304) 636-3300

501 Railroad Ave
Elkins, WV 26241
Phone (304) 636-5006

150 Memorial Dr
Kingwood, WV 26537
Phone (304) 329-4701

Interoperability endpoints

  • Direct secure messaging: jacqueline.shipman.p1@direct.davismedicalcenter.nextgenshare.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1464652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714521600000",
    "number": "1154779213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812 GORMAN AVE",
            "city": "ELKINS",
            "state": "WV",
            "postal_code": "262413181",
            "telephone_number": "304-636-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 GORMAN AVE",
            "city": "ELKINS",
            "state": "WV",
            "postal_code": "262413181",
            "telephone_number": "304-636-3300",
            "fax_number": "304-637-3441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIPMAN",
        "first_name": "JACQUELINE",
        "middle_name": "R",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-31",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WV",
            "license": "812",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "SHIPMAN-CESPEDES",
            "middle_name": "R",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Elkins, WV

Sources for this page

Verify at the official NPI Registry.