Individual provider Active NPI

Jeremy M Shefner, M.D.

  • Neurology Physician
  • Phoenix, AZ
National Provider Identifier
1184682882
Registry record updated Sep 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
49535 Issued in AZ
Practice address
240 W Thomas Rd # 400
Phoenix, AZ 85013
Phone
(602) 406-6262
Fax
(602) 406-6261
NPI assigned
May 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 204580 NY
Clinical Neurophysiology Physician 2084N0600X 204580 NY
Neurology Physician 2084N0400X 49535 AZ Primary

Addresses

Primary practice location

240 W Thomas Rd # 400
Phoenix, AZ 85013

Mailing address

240 W Thomas Rd # 400
Phoenix, AZ 85013-4407
Phone (602) 406-6262

Other practice location 1

90 Presidential Plz
4th Floor
Syracuse, NY 13202-2240
Phone (315) 464-4243

Other identifiers 1

IdentifierTypeStateIssuer
01713868MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20150714003097 AZ Practitioner - Neurology 4385658293 Reassigns benefits to 1 organization
I20180117001697 TX Practitioner - Neurology 4385658293 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
204580NYMDClinical Neurophysiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph'S Hospital and Medical Center CurrentSince Aug 30, 2020 Accepting new patients
Sjhmc Physician Services CurrentSince Jun 6, 2015 Accepting new patients
San Carlos Apache Healthcare Corporation CurrentSince Nov 13, 2017 Accepting new patients
St. Joseph'S Outpatient Surgery Center, LLC Current Accepting new patients
St Josephs Pathology Current Accepting new patients
San Carlos Apache Healthcare Corporation CurrentSince Nov 13, 2017 Accepting new patients
Dignity Health Past Accepting new patients

Locations

103 Medicine Way Rd
Peridot, AZ 85542
Phone (928) 475-1200

500 W Thomas Rd
Ste 300A
Phoenix, AZ 85013

240 W Thomas Rd
#400
Phoenix, AZ 85013
Phone (602) 406-6262

240 W Thomas Rd
Ste 401
Phoenix, AZ 85013
Phone (602) 406-6262

500 W Thomas Rd
#300
Phoenix, AZ 85013
Phone (602) 279-7300

240 W Thomas Rd
Ste 400
Phoenix, AZ 85013
Phone (602) 406-6262

500 W Thomas Rd
Ste 680
Phoenix, AZ 85013
Phone (602) 406-6017

350 W Thomas Rd
Phoenix, AZ 85013
Phone (480) 339-5001

2910 N 3rd Ave
Ste 470
Phoenix, AZ 85013
Phone (602) 406-6262

File 56765
Los Angeles, CA 90074

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537315200000",
    "number": "1184682882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 W THOMAS RD # 400",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850134407",
            "telephone_number": "602-406-6262",
            "fax_number": "602-406-6261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 W THOMAS RD # 400",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85013",
            "telephone_number": "602-406-6262",
            "fax_number": "602-406-6261"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "90 Presidential Plz",
            "address_2": "4th Floor",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "132022240",
            "country_code": "US",
            "telephone_number": "315-464-4243",
            "fax_number": "315-464-5350",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHEFNER",
        "first_name": "JEREMY",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-02",
        "last_updated": "2018-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NY",
            "license": "204580",
            "primary": false
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "NY",
            "license": "204580",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "AZ",
            "license": "49535",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01713868",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.