NPIMap

Organization Active NPI

Milton W. Shepperd, DO, PA

  • Geriatric Medicine (Internal Medicine) Physician
  • Meadowlakes, TX
National Provider Identifier
1629149810
Registry record updated May 5, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
J6722 Issued in TX
Legal business name
MILTON W. SHEPPERD, DO, PA
Practice address
113 Broadmoor St
Meadowlakes, TX 78654-6601
Phone
(830) 693-1792
Fax
(830) 693-1685
NPI assigned
Nov 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2009

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

Authorized official

Name
Dr. Milton Wirtz Shepperd, DONPI 1801967096
Title
President
Phone
(830) 693-1792

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X J6722 TX
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RG0300X J6722 TX Primary

Addresses

Primary practice location

113 Broadmoor St
Meadowlakes, TX 78654-6601

Mailing address

PO Box 1930
Marble Falls, TX 78654-2680
Phone (830) 693-1792

Other identifiers 4

IdentifierTypeStateIssuer
176966302MedicaidTX
176966301MedicaidTX
DG9173OtherTXRAILROAD MEDICARE
0068AAOtherTXBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050909000870 TX Part B Supplier - Clinic/Group Practice 0547292583 Receives reassigned benefits from 3 practitioners
Practice locations: Kingsland, TX; Meadowlakes, TX; Marble Falls, TX; Dripping Springs, TX; Cedar Park, TX; Burnet, TX

National Provider Directory

National Provider Directory

Locations

1801 King Rd
Marble Falls, TX 78654
Phone (830) 613-3260

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1163203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241481600000",
    "number": "1629149810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1930",
            "city": "MARBLE FALLS",
            "state": "TX",
            "postal_code": "786542680",
            "telephone_number": "830-693-1792",
            "fax_number": "830-693-1685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 BROADMOOR ST",
            "city": "MEADOWLAKES",
            "state": "TX",
            "postal_code": "786546601",
            "telephone_number": "830-693-1792",
            "fax_number": "830-693-1685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILTON W. SHEPPERD, DO, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-11",
        "last_updated": "2009-05-05",
        "status": "A",
        "authorized_official_last_name": "SHEPPERD",
        "authorized_official_first_name": "MILTON",
        "authorized_official_middle_name": "WIRTZ",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "830-693-1792",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "J6722",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "TX",
            "license": "J6722",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "176966302",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "176966301",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DG9173",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0068AA",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Meadowlakes, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.