Individual provider Active NPI

Brian W Shippert, D.O.

  • Critical Care Medicine (Internal Medicine) Physician
  • State College, PA
National Provider Identifier
1801045133
Registry record updated Aug 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
036155857 Issued in IL
Practice address
1800 E Park Ave
State College, PA 16803-6709
Phone
(814) 278-4818
Fax
(814) 234-6150
NPI assigned
Sep 10, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2021

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Anesthesiology) Physician 207LC0200X OS014818 PA
Emergency Medicine Physician 207P00000X 2010-00473 NC
Emergency Medicine Physician 207P00000X OS11793 FL
Emergency Medicine Physician 207P00000X 0102203823 VA
Emergency Medicine Physician 207P00000X OS014818 PA
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 036155857 IL Primary

Addresses

Primary practice location

1800 E Park Ave
State College, PA 16803-6709

Mailing address

1800 E Park Ave
State College, PA 16803-6709
Phone (814) 278-4818

Other practice location 1

800 E Carpenter St
Springfield, IL 62769-6709
Phone (217) 544-6464

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, FL, GA, IL4 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20091023000608 PA Practitioner - Critical Care (Intensivists)Practitioner - Emergency Medicine 0547307563 Reassigns benefits to 2 organizations
I20121204000061 FL Practitioner - Emergency Medicine 0547307563 Reassigns benefits to 1 organization
I20210225001805 GA Practitioner - Critical Care (Intensivists) 0547307563 Reassigns benefits to 1 organization
I20210908001101 IL Practitioner - Critical Care (Intensivists) 0547307563 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: Emergency Medicine
Education
Arizona College of Osteopathic Medicine Mid Western University, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mount Nittany Medical Center Health Services IncGroup PAC ID 8426136797, 366 clinicians

Practice addresses (Care Compare)

129 Medical Park LN
Bellefonte, PA 16823-9112
Phone (814) 355-3626

141 Medical Park LN
Bellefonte, PA 16823-9112
Phone (814) 355-7322

143 Hospital Dr
State College, PA 16803-5500
Phone (814) 237-3470

155 Wellness Way
State College, PA 16803-6702

155 Wellness Way
State College, PA 16803-6797
Phone (814) 231-7000

Hospital & facility affiliations

  • Mount Nittany Medical Center Hospital, State College, PA, CCN 390268

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS11793FLMDEmergency Medicine Physician
2010-00473NCMDEmergency Medicine Physician
OS014818PAMDEmergency Medicine Physician
0102203823VAMDEmergency Medicine Physician
036155857ILMDCritical Care Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Apogee Medical Group of Pennsylvania PC CurrentSince Sep 4, 2022 Accepting new patients
Northeast Georgia Physicians Group Inc Critical Care Medicine CurrentSince Dec 9, 2020 Accepting new patients
SJL Health Systems Inc CurrentSince Sep 20, 2021 Accepting new patients
Apogee Medical Group of Pennsylvania PC CurrentSince Sep 4, 2022 Accepting new patients
HSHS Medical Group Inc Current Accepting new patients
HSHS Medical Group Inc CurrentSince Sep 20, 2021 Accepting new patients
Mount Nittany Medical Center Health Services Inc CurrentSince Nov 29, 2016 Accepting new patients
Intensive Care Consortium Inc Critical Care Medicine CurrentSince Aug 14, 2013 Accepting new patients
Emergency Medicine Physicians of Craven County, PLLC Emergency Medicine Past Accepting new patients

Locations

2001 Kingsley Ave
Orange Park, FL 32073
Phone (904) 215-7015

1400 River Pl
Braselton, GA 30517
Phone (770) 219-6000

743 Spring St NE
Gainesville, GA 30501
Phone (770) 219-5915

597 S Enota Dr NE
Gainesville, GA 30501
Phone (770) 219-8275

1900 E Lake Shore Dr
Ste 330
Decatur, IL 62521
Phone (217) 423-2889

1512 N Green Mount Rd
O Fallon, IL 62269
Phone (618) 624-0100

800 E Carpenter St
Springfield, IL 62769
Phone (217) 525-5643

141 Medical Park Ln
Bellefonte, PA 16823
Phone (814) 355-7322

100 Hospital Ave
Dubois, PA 15801
Phone (814) 375-2040

100 Hospital Ave
Ofc
Dubois, PA 15801

1225 Warm Springs Ave
Huntingdon, PA 16652
Phone (814) 643-8206

1086 Franklin St
Johnstown, PA 15905
Phone (610) 250-4540

1850 E Park Ave
Ste 201
State College, PA 16803
Phone (814) 234-8800

155 Wellness Way
State College, PA 16803
Phone (800) 367-0179

Organizations & group practices 9

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1221004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630022400000",
    "number": "1801045133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 E PARK AVE",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168036709",
            "telephone_number": "814-278-4818",
            "fax_number": "814-234-6150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 E PARK AVE",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168036709",
            "telephone_number": "814-278-4818",
            "fax_number": "814-234-6150"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 E Carpenter St",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "IL",
            "postal_code": "627696709",
            "country_code": "US",
            "telephone_number": "217-544-6464",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIPPERT",
        "first_name": "BRIAN",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-10",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LC0200X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Critical Care Medicine",
            "state": "PA",
            "license": "OS014818",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "2010-00473",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "OS11793",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VA",
            "license": "0102203823",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "OS014818",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "IL",
            "license": "036155857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in State College, PA

Sources for this page

Verify at the official NPI Registry.