Active NPI
Robert Edward Shepherd, MD
- Diagnostic Radiology Physician
- Greensboro, NC
National Provider Identifier
1790733780
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 24708
- Practice address
- 1317 N Elm St
Suite 1B
Greensboro, NC 27401-1023 - Phone
- (336) 274-4285
- Fax
- (336) 482-2177
- NPI assigned
- May 4, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 24708 | NC | Primary |
| Neuroradiology Physician | 2085N0700X | 0024708 | NC |
Addresses
Primary practice location
1317 N Elm St
Suite 1B
Greensboro, NC 27401-1023
Mailing address
1317 N Elm Street
Suite 1 B
Greensboro, NC 27401-1023
Phone (336) 274-4285
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1600280 | Other | NC | UNITED HEALTHCARE |
| 1085 | Other | NC | PARTNERS |
| 300065910 | Other | NC | RAILROAD MEDICARE |
| 8975686 | Medicaid | NC | |
| 1790733780 | Medicaid | VA | |
| 70516 | Other | NC | MEDCOST |
| 75686 | Other | NC | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0024708 | NC | MD | Neuroradiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1292803200000",
"number": "1790733780",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1317 N ELM STREET",
"address_2": "SUITE 1 B",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274011023",
"telephone_number": "336-274-4285",
"fax_number": "336-482-2177"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1317 N ELM ST",
"address_2": "SUITE 1B",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274011023",
"telephone_number": "336-274-4285",
"fax_number": "336-482-2177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEPHERD",
"first_name": "ROBERT",
"middle_name": "EDWARD",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-04",
"last_updated": "2010-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "NC",
"license": "24708",
"primary": true
},
{
"code": "2085N0700X",
"taxonomy_group": "",
"desc": "Radiology, Neuroradiology",
"state": "NC",
"license": "0024708",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "1600280",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PARTNERS",
"identifier": "1085",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "300065910",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8975686",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1790733780",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST",
"identifier": "70516",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "75686",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greensboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.