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Individual provider Active NPI

Jessica Ann Shrock, FNP--C

  • Family Nurse Practitioner
  • Bandon, OR
National Provider Identifier
1184075715
Registry record updated May 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
10035565 Issued in OR
Practice address
110 10TH St SE
Bandon, OR 97411-9157
Phone
(541) 347-5191
Fax
(541) 266-4578
NPI assigned
Jun 24, 2016
Last updated
May 9, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 21334 TN
Family Nurse Practitioner 363LF0000X 10035565 OR Primary

Addresses

Primary practice location

110 10TH St SE
Bandon, OR 97411-9157

Mailing address

1900 Woodland Dr
Coos Bay, OR 97420-2099
Phone (541) 267-5151

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, OR2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20161129000415 TN Practitioner - Nurse Practitioner 0345520847 Reassigns benefits to 1 organization
I20250113002274 OR Practitioner - Nurse Practitioner 0345520847 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Bend Medical Center IncGroup PAC ID 5597677716, 92 clinicians

Practice addresses (Care Compare)

110 E 10TH St
Bandon, OR 97411-9157
Phone (541) 396-3111

1900 Woodland Dr
Coos Bay, OR 97420-2045
Phone (541) 267-5151

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.64 of 100Reported as group
Quality
74.2
Promoting interoperability
99
Improvement activities
40
Cost
66.56

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
21334TNMDRheumatology Physician
10035565ORMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
North Bend Medical Center Inc CurrentSince Mar 1, 2025 Accepting new patients
North Bend Medical Center Inc CurrentSince Mar 1, 2025 Accepting new patients
Healogics Specialty Physicians of Tennessee, PLLC CurrentSince Sep 28, 2016 Accepting new patients
Wild Rivers Emergency Physicians LLC Past Accepting new patients

Locations

110 10th St SE
Bandon, OR 97411
Phone (541) 347-1515

1900 Woodland Dr
Coos Bay, OR 97420
Phone (541) 267-5151

1801 N Jackson St
Tullahoma, TN 37388
Phone (931) 393-3000

Organizations & group practices 4

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 6

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": "1466726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746748800000",
    "number": "1184075715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 WOODLAND DR",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202099",
            "telephone_number": "541-267-5151",
            "fax_number": "541-266-4578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 10TH ST SE",
            "city": "BANDON",
            "state": "OR",
            "postal_code": "974119157",
            "telephone_number": "541-347-5191",
            "fax_number": "541-266-4578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHROCK",
        "first_name": "JESSICA",
        "middle_name": "ANN",
        "credential": "FNP--C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-24",
        "last_updated": "2025-05-09",
        "certification_date": "2025-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "21334",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "10035565",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bandon, OR

Sources for this page

Verify at the official NPI Registry.