Jonathan Lane Shepard, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA.0004608 Issued in CO

Practice address

1413 N Mildred Rd
Cortez, CO 81321-2258

Phone

(970) 564-1037

Fax

(970) 564-1041

NPI assigned

Jan 28, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO, TX2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• DHHS, PHS, Naihs, Shiprock Hospital

  dba Northern Navajo Medical Center

  • General Acute Care Hospital
  • Shiprock, NM
  • NPI 1780639971

  TX

  Medicare reassignment NPD
• Southwest Health System Inc

  dba Southwest Memorial Hospital

  • Critical Access Hospital
  • Cortez, CO
  • NPI 1649241571
  Medicare reassignment
• Southwest Health System, Inc.

  dba Southwest Walk-in Care

  • Rural Health Clinic/Center
  • Cortez, CO
  • NPI 1083917868
  NPD
• Southwest Health System, Inc.

  dba Southwest Health System Pharmacy

  • Pharmacy
  • Cortez, CO
  • NPI 1386917862
  NPD
• Southwest Health System, Inc.

  dba Southwest Medical Group - Primary Care

  • Rural Health Clinic/Center
  • Cortez, CO
  • NPI 1578689527
  NPD
• Southwest Health System, Inc.

  dba Southwest Memorial Physicians

  • Multi-Specialty Clinic/Center
  • Cortez, CO
  • NPI 1932475894
  NPD
• DHHS, PHS, Naihs, Shiprock Hospital

  • General Acute Care Hospital
  • Teec Nos Pos, AZ
  • NPI 1477615789
  NPD

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

{
    "created_epoch": "1359331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730764800000",
    "number": "1205174174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1413 N MILDRED RD",
            "city": "CORTEZ",
            "state": "CO",
            "postal_code": "813212258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1413 N MILDRED RD",
            "city": "CORTEZ",
            "state": "CO",
            "postal_code": "813212258",
            "telephone_number": "970-564-1037",
            "fax_number": "970-564-1041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEPARD",
        "first_name": "JONATHAN",
        "middle_name": "LANE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-01-28",
        "last_updated": "2024-11-05",
        "certification_date": "2024-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0004608",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Charlee Sharp, CAS
• Courtney W. Sikes, DMD
• Silver Lining Advanced Life Planning LLC (Silver Lining ALP)
• Smart Dentistry
• Jared Eugene Smith
• Jason Kent Smith, D.D.S.

• Physician Assistant in Cortez, CO
• Providers in Cortez, CO by specialty
• Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2024; 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.