Mary Kristen Shipley, PT

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

11480 Issued in NC

Practice address

2410 Susannah St
Johnson City, TN 37601-1748

Phone

(423) 282-9011

NPI assigned

Feb 7, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Kristen Shipley Minor Professional name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC, TN2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

East Tennessee State University Quillen College of Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Watauga Orthopaedics PLCGroup PAC ID 1456246479, 85 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

89.07 of 100Reported as group

Quality

85.94

Promoting interoperability

100

Improvement activities

40

Cost

77.63

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mary.shipley.1@3374.direct.athenahealth.com

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.

• Watauga Orthopaedics PLC

  • Orthopaedic Surgery Physician
  • Johnson City, TN
  • NPI 1245251404

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Emergeortho PA

  • Orthopaedic Surgery Physician
  • Durham, NC
  • NPI 1376592964

  Physical Therapist

  Medicare reassignment NPD
• Watauga Orthopaedics, PLC

  • Durable Medical Equipment & Medical Supplies
  • Greeneville, TN
  • NPI 1730924192

  Physical Therapist

  NPD
• Emergeortho PA

  • Durable Medical Equipment & Medical Supplies
  • Eden, NC
  • NPI 1841170222
  NPD

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

{
    "created_epoch": "1202342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1790963155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2410 SUSANNAH ST",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376011748",
            "telephone_number": "423-282-9011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2410 SUSANNAH ST",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376011748",
            "telephone_number": "423-282-9011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3200 Northline Ave Ste 160",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274087613",
            "country_code": "US",
            "telephone_number": "336-545-5000",
            "fax_number": "336-545-5020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIPLEY",
        "first_name": "MARY",
        "middle_name": "KRISTEN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-07",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "11480",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NC",
            "license": "11480",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "Q36607A",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "Q36607B",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1790963155",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "heather.scholz@emergeortho.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3200 Northline Ave Ste 160",
            "city": "Greensboro",
            "state": "NC",
            "country_code": "US",
            "postal_code": "274087613",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KRISTEN",
            "last_name": "MINOR",
            "middle_name": "SHIPLEY",
            "credential": "PT",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Steven John Sherfey, COUNSELOR
• Tara S Shields, MD
• Jay Richard Shilling, LCSW
• Dong H Shin, CRNA
• Jackie Shipley
• Sarah Elizabeth Shipley
• Jessica Shirley, SLP
• Roger Dwayne Shockey Sr., FNP
• Christopher W. Sholes, MD
• Laura Ann Sholes, APN-BC

• Orthopedic Physical Therapist in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Orthopedic Physical Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.