NPIMap

Individual provider Active NPI

John Paul Shoup, M.D.

  • Internal Medicine Physician
  • Wentzville, MO
National Provider Identifier
1427476100
Registry record updated Feb 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2019009766 Issued in MO
Practice address
1520 Wentzville Pkwy
Wentzville, MO 63385-3408
Phone
(636) 497-4000
Fax
(636) 497-4001
NPI assigned
Mar 31, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2018-00418 NC
Pediatrics Physician 208000000X 2019009766 MO
Internal Medicine Physician 207R00000X 2019009766 MO Primary

Addresses

Primary practice location

1520 Wentzville Pkwy
Wentzville, MO 63385-3408

Mailing address

1520 Wentzville Pkwy
Wentzville, MO 63385-3408
Phone (636) 497-4000

Other practice location 1

801 Medical Dr Ste 400
Wentzville, MO 63385-3824
Phone (636) 327-3100

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20190805001029 MO Practitioner - Internal MedicinePractitioner - Pediatric Medicine 3072860584 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
University of Connecticut School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Physician Groups LCGroup PAC ID 3072421254, 526 clinicians
Aging Well Health Care, LLCGroup PAC ID 1153232038, 236 clinicians

Practice addresses (Care Compare)

1520 Wentzville Pkwy
Wentzville, MO 63385-3408
Phone (636) 497-4000

7212 Balson Ave
Saint Louis, MO 63130-3001

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2018-00418NCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Groups LC Internal Medicine CurrentSince Jul 1, 2019 Accepting new patients
Physician Groups LC CurrentSince Jul 1, 2019 Accepting new patients

Locations

2630 Highway K
O Fallon, MO 63368
Phone (636) 240-5454

801 Medical Dr
Ste 400
Wentzville, MO 63385
Phone (636) 327-3100

1520 Wentzville Pkwy
Wentzville, MO 63385
Phone (636) 497-4000

Interoperability endpoints

  • Direct secure messaging: jshoup1017628@direct.carenet.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 9

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": "1396224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613088000000",
    "number": "1427476100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 WENTZVILLE PKWY",
            "city": "WENTZVILLE",
            "state": "MO",
            "postal_code": "633853408",
            "telephone_number": "636-497-4000",
            "fax_number": "636-497-4001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 WENTZVILLE PKWY",
            "city": "WENTZVILLE",
            "state": "MO",
            "postal_code": "633853408",
            "telephone_number": "636-497-4000",
            "fax_number": "636-497-4001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 Medical Dr Ste 400",
            "address_purpose": "LOCATION",
            "city": "Wentzville",
            "state": "MO",
            "postal_code": "633853824",
            "country_code": "US",
            "telephone_number": "636-327-3100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHOUP",
        "first_name": "JOHN",
        "middle_name": "PAUL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-31",
        "last_updated": "2021-02-12",
        "certification_date": "2021-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2018-00418",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2019009766",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2019009766",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1520 Wentzville Pkwy",
            "city": "Wentzville",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633853408",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wentzville, MO

Sources for this page

Verify at the official NPI Registry.