Skyler Shane Shippen, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MRM-1552 Issued in ID

Practice address

465 Memorial Dr
Pocatello, ID 83201-4008

Phone

(208) 282-4696

NPI assigned

Jun 13, 2016

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

Medicare fee-for-service enrollment

Enrolled in ID

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

Specialty

Family Practice

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Lukes Clinic LLCGroup PAC ID 1052217478, 313 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hospice Visions Hospice, Twin Falls, ID, CCN 131524
• St Lukes Magic Valley Medical Center Hospital, Twin Falls, ID, CCN 130002
• St Luke'S Jerome Hospital, Jerome, ID, CCN 131310
• St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sshippen80249@direct.slhs.org

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.

• St Luke'S Clinic LLC

  • Family Medicine Physician
  • Twin Falls, ID
  • NPI 1790718229
  Medicare reassignment Care Compare group NPD
• St Luke'S Magic Valley Regional Medical Center LTD

  • Community/Retail Pharmacy
  • Twin Falls, ID
  • NPI 1760203921
  NPD (past)

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

• Hospice Visions, LLC

  • Community Based Hospice Care Agency
  • Twin Falls, ID
  • NPI 1376276030
  Care Compare affiliation
• St Luke'S Magic Valley Regional Medical Center LTD

  • Critical Access Hospital
  • Jerome, ID
  • NPI 1366874877
  Care Compare affiliation
• St Lukes Regional Medical Center

  • Ambulance
  • Boise, ID
  • NPI 1518115195

  Hospital

  Care Compare affiliation
• St Lukes Regional Medical Center

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1770586794
  Care Compare affiliation
• St. Luke'S Magic Valley Regional Medical Center, LTD.

  • General Acute Care Hospital
  • Twin Falls, ID
  • NPI 1932154705
  Care Compare affiliation

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

{
    "created_epoch": "1465776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465776000000",
    "number": "1194174995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "465 MEMORIAL DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014008",
            "telephone_number": "208-282-4696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "465 MEMORIAL DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014008",
            "telephone_number": "208-282-4696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIPPEN",
        "first_name": "SKYLER",
        "middle_name": "SHANE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-13",
        "last_updated": "2016-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "MRM-1552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan R Shelton, MD
• Brady Kyle Shepherd
• Stephen Arthur Sherman, MD
• Scott Shi, PA
• Christopher C Shields, MD
• Jo Anna Shotiveyaratana, MA, LPC
• Jessica Shotwell, SLP
• Alex Michael Shreiber, PHARMD
• Shudl LLC
• Tyrone Richard Shuman, LCSW

• Family Medicine Physician in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2016; 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.
• 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.