Individual provider Active NPI

Jordan Ashley Shipley, PA-C

  • Physician Assistant
  • Indianola, IA
National Provider Identifier
1679098040
Registry record updated May 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
088089 Issued in IA
Practice address
307 E Scenic Valley Ave
Indianola, IA 50125-4865
Phone
(515) 961-8448
Fax
(515) 643-9100
NPI assigned
Aug 7, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 088089 IA Primary

Addresses

Primary practice location

307 E Scenic Valley Ave
Indianola, IA 50125-4865

Mailing address

PO Box 1475
Des Moines, IA 50305-1475
Phone (515) 961-8448

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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

Enrollment IDStateProvider typePAC IDDetails
I20170828004584 IA Practitioner - Physician Assistant 1557634466 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinics IncGroup PAC ID 7911810882, 441 clinicians

Practice addresses (Care Compare)

2006 N 4TH St
Indianola, IA 50125-4500

307 E Scenic Valley Ave
Indianola, IA 50125-4865

330 Laurel St
Suite 1200
Des Moines, IA 50314-3044
Phone (515) 643-6290

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
088089IAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinics, Inc. CurrentSince Aug 16, 2017 Accepting new patients

Locations

405 SW 5th St
Ste E
Des Moines, IA 50309
Phone (515) 358-7259

307 E Scenic Valley Ave
Indianola, IA 50125
Phone (515) 961-8448

Interoperability endpoints

  • Direct secure messaging: jshipley3957480@direct.trinity-health.org

Organizations & group practices 2

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.

Hospital & facility affiliations 5

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": "1502064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683072000000",
    "number": "1679098040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1475",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503051475",
            "telephone_number": "515-961-8448",
            "fax_number": "515-643-9100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 E SCENIC VALLEY AVE",
            "city": "INDIANOLA",
            "state": "IA",
            "postal_code": "501254865",
            "telephone_number": "515-961-8448",
            "fax_number": "515-643-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIPLEY",
        "first_name": "JORDAN",
        "middle_name": "ASHLEY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-07",
        "last_updated": "2023-05-03",
        "certification_date": "2023-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "088089",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianola, IA

Sources for this page

Verify at the official NPI Registry.