Active NPI
Debra Shinkle, MD
- Family Medicine Physician
- Stansbury PK, UT
National Provider Identifier
1790874238
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 198054-1205
- Practice address
- 220 Millpond Ste 100
Stansbury PK, UT 84074-9760 - Phone
- (435) 843-3000
- NPI assigned
- Oct 12, 2006
- Last updated
- Nov 8, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| 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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New 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.
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-
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-
dba Adventist Health Medical Group Prosser Clinic
- Multi-Specialty Clinic/Center
- Prosser, WA
- NPI 1376894048
-
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- NPI 1629048848
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.