Jon R Shereck, MD

Primary specialty

Orthopaedic Trauma PhysicianTaxonomy code 207XX0801X

License

59429 Issued in AZ

Practice address

107 E Oak Ave
Flagstaff, AZ 86001

Phone

(928) 779-7880

Fax

(928) 913-8801

NPI assigned

Aug 31, 2005

Last updated

Nov 26, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in MN, CA2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

• Altru Health System

  dba Altru Clinic Crookston

  • Clinic/Center
  • Crookston, MN
  • NPI 1760494330
  Medicare reassignment NPD
• Regents of the University of California

  • Orthopaedic Surgery Physician
  • San Diego, CA
  • NPI 1225130677
  Medicare reassignment NPD
• Altru Health System

  dba Altru Clinic - Thief River Falls

  • Rural Health Clinic/Center
  • Thief River Falls, MN
  • NPI 1285074328
  NPD
• Regents of the University of California

  • Diagnostic Radiology Physician
  • San Diego, CA
  • NPI 1558463927
  NPD
• Alegent Creighton Clinic

  dba CHI Health Clinic

  • Internal Medicine Physician
  • Omaha, NE
  • NPI 1154680700
  NPD (past)
• Clinic Pharmacy Inc

  • Community/Retail Pharmacy
  • Devils Lake, ND
  • NPI 1184718876
  NPD (past)
• Creighton University

  dba Creighton Medical Associates

  • Allergy & Immunology (Internal Medicine) Physician
  • Omaha, NE
  • NPI 1295777225
  NPD (past)
• Creighton University

  dba Creighton Therapy and Wellness

  • Physical Therapist
  • Omaha, NE
  • NPI 1780172304
  NPD (past)

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574726400000",
    "number": "1316931702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 E OAK AVE",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "86001",
            "telephone_number": "928-779-7880",
            "fax_number": "928-913-8801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 E OAK AVE",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "86001",
            "telephone_number": "928-779-7880",
            "fax_number": "928-913-8801"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 W Arbor Dr",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "92103",
            "country_code": "US",
            "telephone_number": "858-657-8200",
            "fax_number": "858-657-8235",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHERECK",
        "first_name": "JON",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-31",
        "last_updated": "2019-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "C153955",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "ND",
            "license": "7631",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NE",
            "license": "23059",
            "primary": false
        },
        {
            "code": "207XX0801X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Trauma",
            "state": "AZ",
            "license": "59429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Leonard Shaw, M.D.
• Sarah Crawford Shearer
• William Nelson Sheehan, M.D.
• Jordan Aiden Sheen
• Alison Patricia Shepherd, LCSW
• Sheridan Children's Healthcare Services of Arizona, Inc.
• Janet Sheridan, MA
• Kathy Sherman, NP
• Thea Sherman, NUTRITION THERAPIST
• Dithi A Shetty, MD

• Orthopaedic Trauma Physician in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Orthopaedic Trauma Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2019; 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.