Individual provider Active NPI

Ezekiel Grant Shepherd

  • Physician Assistant
  • Cary, NC
National Provider Identifier
1679234330
Registry record updated Mar 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
100 Cornerstone Dr
Cary, NC 27519-8453
Phone
(919) 650-3660
NPI assigned
Jan 5, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 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 NC Primary

Addresses

Primary practice location

100 Cornerstone Dr
Cary, NC 27519-8453

Mailing address

178 Keith Weathers Rd
Fuquay Varina, NC 27526-7477
Phone (336) 466-3201

Other practice location 1

215 Brightwater Dr
Lillington, NC 27546-5156
Phone (910) 892-1000

Other practice location 2

800 Tilghman Dr
Dunn, NC 28334-5510
Phone (910) 892-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20221019003483 NC Practitioner - Physician Assistant 4486020211 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fastmed PCGroup PAC ID 9830540558, 174 clinicians

Practice addresses (Care Compare)

100 Cornerstone Dr
Cary, NC 27519-8453
Phone (919) 650-3660

7010 NC Hwy 751
Durham, NC 27707-5733
Phone (919) 313-3900

Merit-based Incentive Payment System (MIPS)

Final score
74.09 of 100Reported as group
Quality
65.78
Improvement activities
40
Cost
76.37

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Fastmed Primary Care, P.C. Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: esheperd99564@capefearvalley.direct-ci.com

Organizations & group practices 3

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": "1641340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679961600000",
    "number": "1679234330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "178 KEITH WEATHERS RD",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275267477",
            "telephone_number": "336-466-3201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CORNERSTONE DR",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275198453",
            "telephone_number": "919-650-3660"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "215 Brightwater Dr",
            "address_purpose": "LOCATION",
            "city": "Lillington",
            "state": "NC",
            "postal_code": "275465156",
            "country_code": "US",
            "telephone_number": "910-892-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "800 Tilghman Dr",
            "address_purpose": "LOCATION",
            "city": "Dunn",
            "state": "NC",
            "postal_code": "283345510",
            "country_code": "US",
            "telephone_number": "910-892-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHEPHERD",
        "first_name": "EZEKIEL",
        "middle_name": "GRANT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-05",
        "last_updated": "2023-03-28",
        "certification_date": "2023-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cary, NC

Sources for this page

Verify at the official NPI Registry.