Individual provider Active NPI

Spencer Daniel Shepherd, MD

  • Anesthesiology Physician
  • Portland, OR
National Provider Identifier
1255869350
Registry record updated Apr 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD218964 Issued in OR
Practice address
707 SW Washington St # 1801
Portland, OR 97205-3536
Phone
(503) 299-9906
Fax
(503) 225-9002
NPI assigned
Jun 1, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD218964 OR Primary
Anesthesiology Physician 207L00000X 4301504320 MI

Addresses

Primary practice location

707 SW Washington St # 1801
Portland, OR 97205-3536

Mailing address

PO Box 35147
#1801
Seattle, WA 98124-5147

Other practice location 1

100 Michigan St NE
Grand Rapids, MI 49503-2560
Phone (616) 364-4200

Other practice location 2

3333 Evergreen Dr NE
Grand Rapids, MI 49525-9493
Phone (616) 364-4200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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

Enrollment IDStateProvider typePAC IDDetails
I20240523002560 OR Practitioner - Anesthesiology 0648549477 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Michigan State University College of Human Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oregon Anesthesiology Group PCGroup PAC ID 3476451659, 239 clinicians

Practice addresses (Care Compare)

2801 N Gantenbein Ave
Portland, OR 97227-1623
Phone (503) 299-9906

Hospital & facility affiliations

  • Legacy Emanuel Medical Center Hospital, Portland, OR, CCN 380007

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD218964ORMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Oregon Anesthesiology Group PC Anesthesiology CurrentSince May 1, 2024 Accepting new patients
University of Chicago Medical Center Past Accepting new patients
Oag Trauma Services LLC Anesthesiology Past Accepting new patients

Locations

707 SW Washington St
Ste 700
Portland, OR 97205

707 SW Washington St
#1801
Portland, OR 97205

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

Organizations & group practices 3

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1496275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712102400000",
    "number": "1255869350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35147",
            "address_2": "#1801",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981245147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 SW WASHINGTON ST # 1801",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972053536",
            "telephone_number": "503-299-9906",
            "fax_number": "503-225-9002"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Michigan St NE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495032560",
            "country_code": "US",
            "telephone_number": "616-364-4200",
            "fax_number": "616-364-7347",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3333 Evergreen Dr NE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495259493",
            "country_code": "US",
            "telephone_number": "616-364-4200",
            "fax_number": "616-364-7347",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHEPHERD",
        "first_name": "SPENCER",
        "middle_name": "DANIEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-01",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OR",
            "license": "MD218964",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MI",
            "license": "4301504320",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.