Individual provider Active NPI

Caitlin Goodman Sheppard, PA

  • Physician Assistant
  • Winston Salem, NC
National Provider Identifier
1255783445
Registry record updated Apr 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-06583 Issued in NC
Practice address
2810 Maplewood Ave
Winston Salem, NC 27103-4138
Phone
(336) 860-6194
Fax
(336) 860-6236
NPI assigned
Jul 12, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-06583 NC Primary

Addresses

Primary practice location

2810 Maplewood Ave
Winston Salem, NC 27103-4138

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Other practice location 1

101 E W T Harris Blvd
Ste 5401
Charlotte, NC 28262-3485
Phone (704) 863-9700

Other practice location 2

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277-3372
Phone (704) 667-2650

Other practice location 3

10226 Couloak Dr
Ste 100
Charlotte, NC 28216-7675
Phone (704) 801-7380

Other practice location 4

150 Professional Park Dr
Ste 400
Mooresville, NC 28117-5603
Phone (704) 801-7360

Other practice location 5

101 E W T Harris Blvd
Ste 5002
Charlotte, NC 28262-3485
Phone (704) 801-7310

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address csheppard413528@CarolinasHealthcareSystem.direct-ci.com Atrium Health
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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 1

Enrollment IDStateProvider typePAC IDDetails
I20161003000105 NC Practitioner - Physician Assistant 3072800200 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
NH-CL Clinics LLCGroup PAC ID 6305262692, 82 clinicians

Practice addresses (Care Compare)

2810 Maplewood Ave
Winston Salem, NC 27103-4138
Phone (336) 860-6194

500 Pineview Dr
Suite 205
Kernersville, NC 27284-3814
Phone (336) 329-3295

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-06583NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Physicians Network Inc CurrentSince May 1, 2020 Accepting new patients
Carolinas Physicians Network Inc CurrentSince May 1, 2020 Accepting new patients
Carolinas Physicians Network Inc CurrentSince May 1, 2020 Accepting new patients
Neurosurgical Associates of the CurrentSince Apr 9, 2024 Accepting new patients
Emergency Medicine Physicians of Iredell County, PLLC Past Accepting new patients

Locations

100 N 6th St
Ste 900A
Minneapolis, MN 55403

101 E Wt Harris Blvd
Ste 5401
Charlotte, NC 28262
Phone (704) 863-1400

2001 Vail Ave
Charlotte, NC 28207
Phone (704) 304-5000

101 E Wt Harris Blvd
Ste 5002
Charlotte, NC 28262
Phone (704) 548-8724

10226 Couloak Dr
Ste 100
Charlotte, NC 28216
Phone (704) 801-7380

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650

16455 Statesville Rd
Ste 360
Huntersville, NC 28078
Phone (704) 801-3300

150 Professional Park Dr
Ste 400
Mooresville, NC 28117
Phone (704) 801-7350

557 Brookdale Dr
Statesville, NC 28677
Phone (330) 445-4361

2810 Maplewood Ave
Winston Salem, NC 27103
Phone (336) 768-1811

Interoperability endpoints

  • Direct secure messaging: csheppard413528@carolinashealthcaresystem.direct-ci.com
  • Direct secure messaging: csheppard863926@direct.novanthealth.org

Organizations & group practices 8

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": "1468281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1255783445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2810 MAPLEWOOD AVE",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271034138",
            "telephone_number": "336-860-6194",
            "fax_number": "336-860-6236"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 E W T Harris Blvd",
            "address_2": "Ste 5401",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282623485",
            "country_code": "US",
            "telephone_number": "704-863-9700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14214 Ballantyne Lake Rd",
            "address_2": "Ste 100",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282773372",
            "country_code": "US",
            "telephone_number": "704-667-2650",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10226 Couloak Dr",
            "address_2": "Ste 100",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282167675",
            "country_code": "US",
            "telephone_number": "704-801-7380",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "150 Professional Park Dr",
            "address_2": "Ste 400",
            "address_purpose": "LOCATION",
            "city": "Mooresville",
            "state": "NC",
            "postal_code": "281175603",
            "country_code": "US",
            "telephone_number": "704-801-7360",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "101 E W T Harris Blvd",
            "address_2": "Ste 5002",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282623485",
            "country_code": "US",
            "telephone_number": "704-801-7310",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHEPPARD",
        "first_name": "CAITLIN",
        "middle_name": "GOODMAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-12",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-06583",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "csheppard413528@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "101 E W T Harris Blvd",
            "address_2": "Ste 5002",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282623485",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.