Johnny R Shupe, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024151769 Issued in VA

Practice address

373 Cecil D Quillen Dr
Suite 101
Duffield, VA 24244-4085

Phone

(276) 431-1638

Fax

(276) 431-1639

NPI assigned

Mar 19, 2007

Last updated

Aug 12, 2009By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

University of Tennessee, HSC, College of Medicine, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Regional Health Resources IncGroup PAC ID 3173412707, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Specialist, Nurse Practitioner

Practice roles

Locations

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.

• Regional Health Resources, Inc

  • Primary Care Clinic/Center
  • Duffield, VA
  • NPI 1487681771
  Medicare reassignment Care Compare group NPD
• Regional Health Resources Inc

  • Rural Health Clinic/Center
  • Duffield, VA
  • NPI 1841415619
  NPD
• Tricare Behavorial Health LLC

  dba Stress Care Associates

  • Community/Behavioral Health Agency
  • Kingsport, TN
  • NPI 1891844973
  NPD (past)
• Tricare Behavorial Health, LLC Group

  • Mental Health Counselor
  • Kingsport, TN
  • NPI 1750599650
  NPD (past)

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250035200000",
    "number": "1659495356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3609 HEMLOCK PARK DR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376632063",
            "telephone_number": "423-239-3431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "373 CECIL D QUILLEN DR",
            "address_2": "SUITE 101",
            "city": "DUFFIELD",
            "state": "VA",
            "postal_code": "242444085",
            "telephone_number": "276-431-1638",
            "fax_number": "276-431-1639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUPE",
        "first_name": "JOHNNY",
        "middle_name": "R",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-19",
        "last_updated": "2009-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024151769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ridgecrest Manor Nursing and Rehabilitation, LLC
• Saber Ridgecrest Manor
• Saborah Lee Salvatore, LICENSED PROFESSIONA
• Lauren Elizabeth Setler, FNP
• Julia Eve Shubert
• Travis Shupe, PT
• Brooke Simmons
• Rhonda Faye Simmons
• Regina G Simpson, NP
• Southwest Virginia Home Medical, LLC

• Family Nurse Practitioner in Duffield, VA
• Providers in Duffield, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.