NPIMap

Individual provider Active NPI

Malcolm Shupeck, MD

  • Diagnostic Radiology Physician
  • Cincinnati, OH
National Provider Identifier
1245247436
Registry record updated Apr 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
35-091781 Issued in OH
Practice address
5400 Kennedy Ave
Cincinnati, OH 45213-2664
Phone
(513) 281-3400
Fax
(513) 527-2275
NPI assigned
Aug 1, 2006
Last updated
Apr 1, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 1, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 00-38557 NC
Neurological Surgery Physician 207T00000X 35-091781 OH
Diagnostic Radiology Physician 2085R0202X 35-091781 OH Primary

Addresses

Primary practice location

5400 Kennedy Ave
Cincinnati, OH 45213-2664

Mailing address

5400 Kennedy Ave
Cincinnati, OH 45213-2664
Phone (513) 281-3400

Other identifiers 2

IdentifierTypeStateIssuer
2966474MedicaidOH
8976094MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
00-38557NCMDNeurological Surgery Physician
35-091781OHMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pinehurst Surgical Clinic PA Neurological Surgery Current Accepting new patients
Western Hills Open MRI, LLC Diagnostic Radiology Past Accepting new patients
Proscan Pink Ribbon Center, LLC Diagnostic Radiology Past Accepting new patients
Stadium Open MRI, LLC Diagnostic Radiology PastSince Dec 6, 2022 Accepting new patients
Proscan Radiology, LLC Diagnostic Radiology Past Accepting new patients
Proscan Tylersville, LLC Diagnostic Radiology Past Accepting new patients
Proscan Imaging of Louisville LLC Diagnostic Radiology PastSince Mar 6, 2024 Accepting new patients

Locations

5 First Village Dr
Pinehurst, NC 28374
Phone (910) 235-2713

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

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427846400000",
    "number": "1245247436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5400 KENNEDY AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452132664",
            "telephone_number": "513-281-3400",
            "fax_number": "513-527-2275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 KENNEDY AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452132664",
            "telephone_number": "513-281-3400",
            "fax_number": "513-527-2275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUPECK",
        "first_name": "MALCOLM",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2015-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "NC",
            "license": "00-38557",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "OH",
            "license": "35-091781",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OH",
            "license": "35-091781",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2966474",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8976094",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.