NPIMap

Organization Active NPI

Shepherd Home Health & Hospice LLC

  • Community Based Hospice Care Agency
  • Clinton, OK
National Provider Identifier
1649412396
Registry record updated Mar 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
SHEPHERD HOME HEALTH & HOSPICE LLC
Practice address
812 W Gary Blvd
Clinton, OK 73601-2720
Phone
(580) 323-1580
Fax
(580) 323-2581
NPI assigned
Mar 26, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2009

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

Authorized official

Name
Mr. James Allen Shepherd, BS MT
Title
Ceo/ Administrator
Phone
(580) 323-1580

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

812 W Gary Blvd
Clinton, OK 73601-2720

Mailing address

812 W Gary Blvd
Clinton, OK 73601-2720
Phone (580) 323-1580

Other identifiers 1

IdentifierTypeStateIssuer
200114810AMedicaidOK

Other names 1

  • Shepherd Home Health LLC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060817000090 OK Part A Provider - Home Health Agency 2264435064 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clinton, OK
O20100817000181 OK Part A Provider - Hospice 2264435064 Practice locations: Clinton, OK

Home health agency certification: CCN 377702

Legal name
SHEPHERD HOME HEALTH & HOSPICE LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Oct 25, 2006
Last certification
Aug 3, 2021
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Apr 20, 2006 in OK
Enrollment address
525 S 30TH
Clinton, OK 73601

Hospice certification: CCN 371695

Legal name
SHEPHERD HOME HEALTH & HOSPICE LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Oct 12, 2010
Last certification
May 20, 2022
Ownership / control type
Other
Organization structure
LLCProprietary
Enrollment address
525 S 30TH St
Clinton, OK 73601-3656

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Home health agency

Medicare Care Compare
Listed as
Shepherd Home Health & Hospice, LLCCCN 377702
Overall star rating
3 of 5
Ownership
Proprietary
Certified
Oct 25, 2006
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Care Compare: Hospice

Medicare Care Compare
Listed as
Shepherd Home Health & Hospice, LLCCCN 371695
Ownership
For-Profit
Certified
Oct 12, 2010
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Shepherd Home Health Hospice LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

812 W Gary Blvd
Clinton, OK 73601
Phone (580) 323-1580

525 S 30th St
Clinton, OK 73601
Phone (580) 323-1580

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Melinda Moore Individual 5% Or Greater Direct Ownership Interest Mar 13, 2024 5%
5% Or Greater Direct Ownership InterestExecutive Director/Co-Owner Mar 13, 2024 5%
W-2 Managing EmployeeExecutive Director Mar 13, 2024
Tammy Shepard Individual 5% Or Greater Direct Ownership InterestAdministrator Jun 9, 2006 95%
W-2 Managing EmployeeAd; Jun 9, 2006
5% Or Greater Direct Ownership InterestRN/Administrator/Co-Owner/Ceo Jun 25, 2010 95%
W-2 Managing EmployeeAd; Jun 25, 2010 100%
Mark B Mann Individual Contracted Managing EmployeeMD; Sep 15, 2020

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 16

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1238025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238025600000",
    "number": "1649412396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812 W GARY BLVD",
            "city": "CLINTON",
            "state": "OK",
            "postal_code": "736012720",
            "telephone_number": "580-323-1580",
            "fax_number": "580-323-2581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 W GARY BLVD",
            "city": "CLINTON",
            "state": "OK",
            "postal_code": "736012720",
            "telephone_number": "580-323-1580",
            "fax_number": "580-323-2581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHEPHERD HOME HEALTH & HOSPICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-26",
        "last_updated": "2009-03-26",
        "status": "A",
        "authorized_official_last_name": "SHEPHERD",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "CEO/ ADMINISTRATOR",
        "authorized_official_telephone_number": "580-323-1580",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BS MT"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200114810A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shepherd Home Health LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Clinton, OK

Sources for this page

Verify at the official NPI Registry.