Individual provider Active NPI

Michael D Shaffer, DO

  • Family Medicine Physician
  • Kerrville, TX
National Provider Identifier
1417949983
Registry record updated May 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
L6627 Issued in TX
Practice address
1331 Bandera Hwy Ste 4
Kerrville, TX 78028-9535
Phone
(830) 258-7762
NPI assigned
Aug 19, 2005
Last updated
May 27, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X L6627 TX Primary
Family Medicine Physician 207Q00000X 34-009337 OH
Sports Medicine (Family Medicine) Physician 207QS0010X L6627 TX

Addresses

Primary practice location

1331 Bandera Hwy Ste 4
Kerrville, TX 78028-9535

Mailing address

575 Hill Country Dr
Kerrville, TX 78028-6024

Other identifiers 16

IdentifierTypeStateIssuer
167598508MedicaidTX
90049MedicaidNM
A030OtherNMTRIWEST
139450101OtherTXFIRSTCARE COMMERCIAL
200036040AMedicaidOK
8JE232OtherTXBCBSTX - WCCA
167598506MedicaidTX
90049OtherNMPRESBYTERIAN COMMERCIAL
P01527361OtherTXRAILROAD MEDICARE
139450100MedicaidTX
167598501MedicaidTX
8FE660OtherTXBCBS
8M6326OtherTXBCBS
19229861MedicaidNM
8M0733OtherTXHMO BLUE
2839254MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mshaffer1521402@direct.sw.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20041006001342 TX Practitioner - Family PracticePractitioner - Sports Medicine 0648239574 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
Midwestern University, Chicago College of Osteopathic Med, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

208 Haley Rd
Johnson City, TX 78636-4617
Phone (830) 868-4033

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34-009337OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Decatur Hospital Authority Current Accepting new patients
Peterson Medical Associates Family Medicine CurrentSince May 1, 2023 Accepting new patients

Locations

97 Hitchin Post
Fredericksburg, TX 78624
Phone (830) 307-5002

1331 Bandera Hwy
Ste 4
Kerrville, TX 78028
Phone (830) 258-7762

551 Hill Country Dr
Kerrville, TX 78028
Phone (830) 257-5414

575 Hill Country Dr
Ste 202
Kerrville, TX 78028
Phone (830) 258-6237

Interoperability endpoints

  • Direct secure messaging: michael.shaffer.1@21041.direct.athenahealth.com
  • Direct secure messaging: michaelshaffer@wise.allscriptsdirect.net
  • Direct secure messaging: mshaffer1521402@direct.sw.org

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

Hospital & facility affiliations 7

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": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779840000000",
    "number": "1417949983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 HILL COUNTRY DR",
            "city": "KERRVILLE",
            "state": "TX",
            "postal_code": "780286024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1331 BANDERA HWY STE 4",
            "city": "KERRVILLE",
            "state": "TX",
            "postal_code": "780289535",
            "telephone_number": "830-258-7762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFFER",
        "first_name": "MICHAEL",
        "middle_name": "D",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-19",
        "last_updated": "2026-05-27",
        "certification_date": "2026-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "L6627",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "34-009337",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "TX",
            "license": "L6627",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "167598508",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "90049",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIWEST",
            "identifier": "A030",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRSTCARE COMMERCIAL",
            "identifier": "139450101",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200036040A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSTX - WCCA",
            "identifier": "8JE232",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "167598506",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRESBYTERIAN COMMERCIAL",
            "identifier": "90049",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01527361",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "139450100",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "167598501",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8FE660",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8M6326",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "19229861",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMO BLUE",
            "identifier": "8M0733",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2839254",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mshaffer1521402@direct.sw.org",
            "affiliation": "N",
            "address_1": "2401 S 31St St",
            "city": "Temple",
            "state": "TX",
            "country_code": "US",
            "postal_code": "765080001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kerrville, TX

Sources for this page

Verify at the official NPI Registry.