NPIMap

Individual provider Active NPI

Zachary James Shipp, M.D.

  • Family Medicine Physician
  • Decatur, IL
National Provider Identifier
1275976094
Registry record updated Dec 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-143808 Issued in IL
Practice address
102 W Kenwood Ave Ste 100
Decatur, IL 62526-4379
Phone
(217) 872-3800
Fax
(217) 872-0849
NPI assigned
Apr 11, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036-143808 IL Primary

Addresses

Primary practice location

102 W Kenwood Ave Ste 100
Decatur, IL 62526-4379

Mailing address

102 W Kenwood Ave Ste 100
Decatur, IL 62526-4379
Phone (217) 872-3800

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address zacharyshipp@siusm.allscriptsdirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170831002536 IL Practitioner - Family Practice 9537384300 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

520 N 4TH St
Springfield, IL 62702-5238
Phone (217) 545-8000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
73.88 of 100Reported as group
Quality
63.91
Improvement activities
40
Cost
77.03

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-143808ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Board of Trustees of Southern Illinois University CurrentSince Feb 5, 2018 Accepting new patients
Decatur Memorial Hospital CurrentSince Aug 9, 2017 Accepting new patients
Board of Trustees of Southern Illinois University Current Accepting new patients
Board of Trustees of Southern Illinois University CurrentSince Feb 5, 2018 Accepting new patients
Board of Trustees of Southern Illinois University Family Medicine Current Accepting new patients
Decatur Memorial Hospital Family Medicine CurrentSince Aug 9, 2017 Accepting new patients
Southern Illinois University Past Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

2300 N Edward St
Decatur, IL 62526
Phone (217) 876-3000

102 W Kenwood Ave
Ste 100
Decatur, IL 62526
Phone (217) 872-3800

241 W Weaver Rd
Ste 145B
Forsyth, IL 62535
Phone (217) 876-5220

200 Stahlhut Dr
Lincoln, IL 62656
Phone (217) 605-5611

520 N 4th St
Springfield, IL 62702
Phone (217) 757-8100

Interoperability endpoints

  • Direct secure messaging: zacharyshipp@siusm.allscriptsdirect.net

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.

Hospital & facility affiliations 3

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": "1365638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607299200000",
    "number": "1275976094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 W KENWOOD AVE STE 100",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625264379",
            "telephone_number": "217-872-3800",
            "fax_number": "217-872-0849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 W KENWOOD AVE STE 100",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625264379",
            "telephone_number": "217-872-3800",
            "fax_number": "217-872-0849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIPP",
        "first_name": "ZACHARY",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-11",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-143808",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "zacharyshipp@siusm.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "102 W Kenwood Ave Ste 100",
            "city": "Decatur",
            "state": "IL",
            "country_code": "US",
            "postal_code": "625264379",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Decatur, IL

Sources for this page

Verify at the official NPI Registry.