Individual provider Active NPI

Shelby Joy Sackett, PA-C

  • Surgical Physician Assistant
  • Medford, OR
National Provider Identifier
1558092759
Registry record updated Aug 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA218037 Issued in OR
Practice address
1698 E McAndrews Rd Ste 400
Medford, OR 97504-5590
Phone
(541) 732-7874
NPI assigned
Jun 20, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA218037 OR Primary

Addresses

Primary practice location

1698 E McAndrews Rd Ste 400
Medford, OR 97504-5590

Mailing address

PO Box 31001
Pasadena, CA 91110-4180
Phone (541) 732-7874

Other identifiers 1

IdentifierTypeStateIssuer
500828634MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20231201000074 OR Practitioner - Physician Assistant 7810345881 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Health and Services OregonGroup PAC ID 5294623245, 166 clinicians

Practice addresses (Care Compare)

1111 Crater Lake Ave
Medford, OR 97504-6241
Phone (541) 732-5545

1698 E McAndrews Rd
Medford, OR 97504-5590

940 Royal Ave
Medford, OR 97504-6194

Hospital & facility affiliations

  • Providence Medford Medical Center Hospital, Medford, OR, CCN 380075

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA218037ORMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon CurrentSince Dec 1, 2023 Accepting new patients
Providence Health & Services - Oregon CurrentSince Dec 1, 2023 Accepting new patients
Providence Health & Services - Oregon CurrentSince Dec 1, 2023 Accepting new patients
Providence Health & Services - Oregon CurrentSince Dec 1, 2023 Accepting new patients
Providence Health & Services - Oregon Past Accepting new patients

Locations

1698 E McAndrews Rd
Ste 400
Medford, OR 97504
Phone (541) 732-6000

940 Royal Ave
Unit 350
Medford, OR 97504
Phone (541) 732-7460

1111 Crater Lake Ave
Medford, OR 97504
Phone (541) 732-5250

Interoperability endpoints

  • Direct secure messaging: ssackett3108146@oc.providencedirect.org

Organizations & group practices 6

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": "1655683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787184000000",
    "number": "1558092759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104180",
            "telephone_number": "541-732-7874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1698 E MCANDREWS RD STE 400",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975045590",
            "telephone_number": "541-732-7874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SACKETT",
        "first_name": "SHELBY",
        "middle_name": "JOY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-20",
        "last_updated": "2026-08-20",
        "certification_date": "2026-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OR",
            "license": "PA218037",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500828634",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.