Individual provider Active NPI

Mary Alice Shepard, M.D.

  • Internal Medicine Physician
  • Vancouver, WA
National Provider Identifier
1669485165
Registry record updated Oct 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD00023639 Issued in WA
Practice address
2211 E Mill Plain Blvd
Vancouver, WA 98661-4329
Phone
(360) 418-6001
Fax
(130) 418-6008
NPI assigned
Aug 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X WA MD00023639 WA
Internal Medicine Physician 207R00000X MD00023639 WA Primary

Addresses

Primary practice location

2211 E Mill Plain Blvd
Vancouver, WA 98661-4329

Mailing address

PO Box 31001-4114
Pasadena, CA 91110-0001

Other practice location 1

624 E Front Ave
Spokane, WA 99202-2139
Phone (509) 626-9900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080314000200 WA Practitioner - Internal Medicine 8527143569 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of California, San Francisco School of Medicine, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Health and Services WashingtonGroup PAC ID 0345139929, 778 clinicians

Practice addresses (Care Compare)

624 E Front Ave
Spokane, WA 99202-2139

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00023639WAMDInternal Medicine Physician
WA MD00023639WAMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest Internal Medicine Current Accepting new patients
Providence Health & Services Washington Internal Medicine CurrentSince Sep 18, 2025 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Internal Medicine CurrentSince Dec 20, 2008 Accepting new patients
Providence Health & Services Washington CurrentSince Sep 18, 2025 Accepting new patients

Locations

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

1200 E Columbia Ave
Colville, WA 99114
Phone (509) 684-3701

1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801

1230 7th Ave
Ofc
Longview, WA 98632
Phone (360) 636-2400

624 E Front Ave
Spokane, WA 99202
Phone (509) 626-9900

7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000

Interoperability endpoints

  • Direct secure messaging: mshepard4080360@wm.providencedirect.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760313600000",
    "number": "1669485165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-4114",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911100001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 E MILL PLAIN BLVD",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986614329",
            "telephone_number": "360-418-6001",
            "fax_number": "130-418-6008"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "624 E Front Ave",
            "address_purpose": "LOCATION",
            "city": "Spokane",
            "state": "WA",
            "postal_code": "992022139",
            "country_code": "US",
            "telephone_number": "509-626-9900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHEPARD",
        "first_name": "MARY",
        "middle_name": "ALICE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-14",
        "last_updated": "2025-10-13",
        "certification_date": "2025-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "WA",
            "license": "WA MD00023639",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD00023639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.