Individual provider Active NPI

Stephanie Shippy, PA-C

  • Physician Assistant
  • Fayetteville, NC
National Provider Identifier
1548628456
Registry record updated Feb 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-06260 Issued in NC
Practice address
1638 Owen Dr
Fayetteville, NC 28304-3424
Phone
(910) 615-8000
Fax
(910) 615-9787
NPI assigned
Feb 5, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-06260 NC Primary

Addresses

Primary practice location

1638 Owen Dr
Fayetteville, NC 28304-3424

Mailing address

1638 Owen Dr
Fayetteville, NC 28304-3424
Phone (910) 615-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160412000256 NC Practitioner - Physician Assistant 5092013888 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wake Emergency Physicians PAGroup PAC ID 9931002078, 269 clinicians

Practice addresses (Care Compare)

2460 Curtis Ellis Dr
Rocky Mount, NC 27804-2237
Phone (252) 962-8000

3000 New Bern Ave
Raleigh, NC 27610-1231
Phone (919) 350-8000

Hospital & facility affiliations

  • Unc Health Nash Hospital, Rocky Mount, NC, CCN 340147

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-06260NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Emergency Physicians PA CurrentSince Jan 1, 2020 Accepting new patients
NHCS Physicians Inc CurrentSince Nov 19, 2024 Accepting new patients
Wake Emergency Physicians PA CurrentSince Jan 1, 2020 Accepting new patients

Locations

3000 New Bern Ave
Raleigh, NC 27610
Phone (919) 350-7000

550 N Winstead Ave
Rocky Mount, NC 27804
Phone (252) 451-3411

2460 Curtis Ellis Dr
Rocky Mount, NC 27804
Phone (252) 443-8199

Organizations & group practices 4

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 1

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": "1454630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454630400000",
    "number": "1548628456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1638 OWEN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043424",
            "telephone_number": "910-615-8000",
            "fax_number": "910-615-9787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1638 OWEN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043424",
            "telephone_number": "910-615-8000",
            "fax_number": "910-615-9787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIPPY",
        "first_name": "STEPHANIE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-05",
        "last_updated": "2016-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-06260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.