Casey Russell Shepherd, DMD MD

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

11502 Issued in MT

Practice address

180 Timberwolf Pkwy
Kalispell, MT 59901-1218

Phone

(406) 755-6014

Fax

(406) 755-6094

NPI assigned

Apr 30, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jun 28, 2016 through Jun 28, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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 and National Provider Directory roles.

• Kalispell Oral Surgery Center LLC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Kalispell, MT
  • NPI 1710652938

  Oral and Maxillofacial Surgery

  NPD

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

{
    "created_epoch": "1272585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628553600000",
    "number": "1720305741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 TIMBERWOLF PKWY",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599011218",
            "telephone_number": "406-755-6014",
            "fax_number": "406-755-6094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 TIMBERWOLF PKWY",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599011218",
            "telephone_number": "406-755-6014",
            "fax_number": "406-755-6094"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "711 13th St E Ste 101",
            "address_purpose": "LOCATION",
            "city": "Whitefish",
            "state": "MT",
            "postal_code": "599372966",
            "country_code": "US",
            "telephone_number": "406-755-6014",
            "fax_number": "406-755-6094",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHEPHERD",
        "first_name": "CASEY",
        "middle_name": "RUSSELL",
        "name_prefix": "Dr.",
        "credential": "DMD MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-30",
        "last_updated": "2021-08-10",
        "certification_date": "2021-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MT",
            "license": "11502",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "MT",
            "license": "11502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Anne Shaw, LCPC
• David G. Sheldon, M.D.
• Shelley Bruce Enterprises, Inc.
• Clayton Roland Shepard, D.D.S.
• Nicky Shepard, MS
• Natalie Sherbrooke, OTD, OTR/L
• Julia Bradshaw Sherrick, CNM
• Robert C. Sherrick, M.D.
• Geraldine Sheu, M.D.
• Julie Renee Shields, NP

• Oral & Maxillofacial Surgery (D.M.D.) in Kalispell, MT
• Providers in Kalispell, MT by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2021; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.