Individual provider Active NPI

Debra Shinkle, MD

  • Family Medicine Physician
  • Stansbury PK, UT
National Provider Identifier
1790874238
Registry record updated Nov 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
198054-1205 Issued in UT
Practice address
220 Millpond Ste 100
Stansbury PK, UT 84074-9760
Phone
(435) 843-3000
NPI assigned
Oct 12, 2006
Last updated
Nov 8, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 198054-1205 UT Primary

Addresses

Primary practice location

220 Millpond Ste 100
Stansbury PK, UT 84074-9760

Mailing address

127 S 500 E
Suite 600
Salt Lake City, UT 84102-1959
Phone (801) 587-6336

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dshinkle132527@direct.med.utah.edu Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Community Physicians Group Family Medicine Current Accepting new patients
Walla Walla General Hospital Past Accepting new patients
Crestwood Medical Group Inc Family Medicine Past Accepting new patients
Wwu Campus Health & Wellness Past Accepting new patients

Locations

1525 W 2100 S
Salt Lake City, UT 84119
Phone (801) 213-8841

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636329600000",
    "number": "1790874238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 S 500 E",
            "address_2": "SUITE 600",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021959",
            "telephone_number": "801-587-6336",
            "fax_number": "801-715-8228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 MILLPOND STE 100",
            "city": "STANSBURY PK",
            "state": "UT",
            "postal_code": "840749760",
            "telephone_number": "435-843-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHINKLE",
        "first_name": "DEBRA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-12",
        "last_updated": "2021-11-08",
        "certification_date": "2021-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "198054-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dshinkle132527@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Stansbury PK, UT

Sources for this page

Verify at the official NPI Registry.