Jennifer A Shockley, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301074526 Issued in MI

Practice address

115 Bridge St
Elk Rapids, MI 49629-5110

Phone

(231) 264-0399

Fax

(231) 264-0212

NPI assigned

Oct 27, 2005

Last updated

Feb 25, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Family Practice

Education

University of Michigan Medical School, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Elk Rapids Primary Care PLCGroup PAC ID 8527029818, 2 clinicians

Great Lakes Therapy Housecalls PCGroup PAC ID 7719876580, shared by 2 NPIs, 71 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Munson Home Care Home health agency, Traverse City, MI, CCN 237025
• Munson Medical Center Hospital, Traverse City, MI, CCN 230097
• Kalkaska Memorial Health Center Hospital, Kalkaska, MI, CCN 231301
• Charlevoix Area Hospital Hospital, Charlevoix, MI, CCN 231322

Merit-based Incentive Payment System (MIPS)

Final score

16.58 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

55.26

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Elk Rapids Primary Care PLC

  • Family Medicine Physician
  • Elk Rapids, MI
  • NPI 1174672968
  Medicare reassignment Care Compare group

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

• Kalkaska Memorial Health Center

  • Critical Access Hospital
  • Kalkaska, MI
  • NPI 1497751309
  Care Compare affiliation
• Munson Healthcare Charlevoix Hospital

  • Critical Access Hospital
  • Charlevoix, MI
  • NPI 1346260692
  Care Compare affiliation
• Munson Home Care

  • Home Health Agency
  • Traverse City, MI
  • NPI 1326002577
  Care Compare affiliation
• Munson Medical Center

  • General Acute Care Hospital
  • Traverse City, MI
  • NPI 1952307852
  Care Compare affiliation

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

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456358400000",
    "number": "1336139658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 888",
            "city": "ELK RAPIDS",
            "state": "MI",
            "postal_code": "496290888",
            "telephone_number": "231-264-0399",
            "fax_number": "231-264-0212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 BRIDGE ST",
            "city": "ELK RAPIDS",
            "state": "MI",
            "postal_code": "496295110",
            "telephone_number": "231-264-0399",
            "fax_number": "231-264-0212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOCKLEY",
        "first_name": "JENNIFER",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-27",
        "last_updated": "2016-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301074526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4415237",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Thomas Steven Rudzinski, DDS
• Maureen Reynolds Street, MD
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• Kathleen Van Pelt, LMSW
• Deirdre A Wickham, DO
• Sophie Wyatt

• Family Medicine Physician in Elk Rapids, MI
• Providers in Elk Rapids, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2016; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.