NPIMap

Individual provider Active NPI

Ian S Shupack, M.D.

  • Family Medicine Physician
  • Mechanicsville, VA
National Provider Identifier
1629186481
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101054440 Issued in VA
Practice address
7571 Cold Harbor Rd
Mechanicsville, VA 23111-1631
Phone
(804) 746-9055
Fax
(804) 746-4476
NPI assigned
Aug 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0101054440 VA Primary

Addresses

Primary practice location

7571 Cold Harbor Rd
Mechanicsville, VA 23111-1631

Mailing address

7571 Cold Harbor Rd
Mechanicsville, VA 23111-1631
Phone (804) 746-9055

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20100210000449 VA Practitioner - Family Practice 8729121991 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Texas a & M University System, HSC, College of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

7571 Cold Harbor Rd
Mechanicsville, VA 23111-1631
Phone (804) 746-9055

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101054440VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mechanicsville Medical Center Family Physicians, P.L.L.C. Family Medicine CurrentSince Jul 20, 1998 Accepting new patients

Locations

7571 Cold Harbor Rd
Mechanicsvlle, VA 23111
Phone (804) 746-9055

Interoperability endpoints

  • Direct secure messaging: ishupack@mmc.ssdirect.aprima.com

Organizations & group practices 1

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 11

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": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629186481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7571 COLD HARBOR RD",
            "city": "MECHANICSVILLE",
            "state": "VA",
            "postal_code": "231111631",
            "telephone_number": "804-746-9055",
            "fax_number": "804-746-4476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7571 COLD HARBOR RD",
            "city": "MECHANICSVILLE",
            "state": "VA",
            "postal_code": "231111631",
            "telephone_number": "804-746-9055",
            "fax_number": "804-746-4476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUPACK",
        "first_name": "IAN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101054440",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mechanicsville, VA

Sources for this page

Verify at the official NPI Registry.