James Ryan Shackelford, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

M-13301 Issued in ID

Practice address

777 N Raymond St
Boise, ID 83704

Phone

(208) 514-2500

Fax

(208) 375-2217

NPI assigned

Feb 2, 2007

Last updated

Dec 20, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Oct 1, 2023 through Oct 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jshackelford295137@direct.ochin.org

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.

• Ryan Shackelford MD, PLLC

  • Psychiatry Physician
  • Boise, ID
  • NPI 1447969506
  NPD Authorized official
• City and County of San Francisco

  dba DSAAM OTOP Methadone Maintenance

  • Methadone Clinic
  • San Francisco, CA
  • NPI 1578787925
  NPD (past)

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703030400000",
    "number": "1639217359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 S OWYHEE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837056014",
            "telephone_number": "208-297-3698",
            "fax_number": "208-561-8051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 N RAYMOND ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83704",
            "telephone_number": "208-514-2500",
            "fax_number": "208-375-2217"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "211 16th Ave N",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836874058",
            "country_code": "US",
            "telephone_number": "208-467-4431",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "211 16th Ave N",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836874058",
            "country_code": "US",
            "telephone_number": "208-467-4431",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHACKELFORD",
        "first_name": "JAMES",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-02",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "NONE",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "NONE",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "ID",
            "license": "M-13301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gina Wolfe Seybold, LICENSED CLINICAL PR
• Madelaine Marie Seyer, CF-SLP
• Steven E Seyfert, RPH
• Eliza Shabire
• Colleen M Shackelford, NP
• Marie Theresa Shackelford, LCSW
• Teresa I Shackelford, LCSW
• Marie Ann Shade, LCPC
• Cyrah Jade Shaff, DPT
• Cassidy Shaffer, LCSW

• Psychiatry Physician in Boise, ID
• Providers in Boise, ID by specialty
• Psychiatry Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.