Mitchell T Shepherd, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

5339107-1206 Issued in UT

Practice address

1350 E 750 N
Suite 1
Orem, UT 84097-4345

Phone

(801) 850-4250

NPI assigned

Jun 27, 2013

Sex

Male

Sole proprietor

Yes

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 UT

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Uhs of Provo Canyon, Inc.

  • Psychiatric Hospital
  • Orem, UT
  • NPI 1457617409
  Medicare reassignment NPD
• Four Corners Community Behavioral Health, Inc.

  • Community/Behavioral Health Agency
  • Price, UT
  • NPI 1487715330
  NPD (past)

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

{
    "created_epoch": "1372291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372291200000",
    "number": "1730529421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 E 750 N",
            "address_2": "SUITE 1",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840974345",
            "telephone_number": "801-850-4250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 E 750 N",
            "address_2": "SUITE 1",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840974345",
            "telephone_number": "801-850-4250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEPHERD",
        "first_name": "MITCHELL",
        "middle_name": "T",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-06-27",
        "last_updated": "2013-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "UT",
            "license": "5339107-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Kay Sheely
• Megan Sheen
• Shaely Shelley
• Marie Shelton, D.O.
• Adam Nicholas Shepherd, D.D.S.
• Cambron Sherman
• Hunter Samuel Sherrow, PA-S
• Alexa Shields
• Kylene Shields, LCSW
• Krista Shimizu, ATC

• Medical Physician Assistant in Orem, UT
• Providers in Orem, UT by specialty
• Medical Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.