Individual provider Active NPI

Christopher Ryan Shepard, M.D.

  • Internal Medicine Physician
  • Fort Defiance, AZ
National Provider Identifier
1558438846
Registry record updated Jun 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD2007-0018 Issued in NM
Practice address
Corner of Route N12 and N7
Fort Defiance, AZ 86504
Phone
(928) 729-8000
NPI assigned
Nov 29, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 10, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35.087635 OH
Internal Medicine Physician 207R00000X MD2007-0018 NM Primary

Addresses

Primary practice location

Corner of Route N12 and N7
Fort Defiance, AZ 86504

Mailing address

PO Box 649
Fort Defiance, AZ 86504-0649

Other practice location 1

1010 Spruce St
Espanola, NM 87532-2724
Phone (505) 753-7111

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
I20070505000059 TX Practitioner - Internal Medicine 9436255569 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

Corner of Route N12 and N7
Fdihb Inc.
Fort Defiance, AZ 86504-0649
Phone (928) 729-8082

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
54661CAMDPharmacist
35.087635OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Fort Defiance Indian Hospital Board, Incorporation CurrentSince Mar 3, 2016 Accepting new patients
The Fort Defiance Indian Hospital Board, Incorporation Current Accepting new patients
DHHS PHS Naihs Fort Defiance Hospital Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560124800000",
    "number": "1558438846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 649",
            "city": "FORT DEFIANCE",
            "state": "AZ",
            "postal_code": "865040649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CORNER OF ROUTE N12 AND N7",
            "city": "FORT DEFIANCE",
            "state": "AZ",
            "postal_code": "86504",
            "telephone_number": "928-729-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1010 Spruce St",
            "address_purpose": "LOCATION",
            "city": "Espanola",
            "state": "NM",
            "postal_code": "875322724",
            "country_code": "US",
            "telephone_number": "505-753-7111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHEPARD",
        "first_name": "CHRISTOPHER",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-29",
        "last_updated": "2019-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35.087635",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NM",
            "license": "MD2007-0018",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Defiance, AZ

Sources for this page

Verify at the official NPI Registry.