Shelly Holder Thompson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME38917 Issued in FL

Practice address

120 King St
Jacksonville, FL 32204-2410

Phone

(904) 760-4904

Fax

(904) 760-4250

NPI assigned

Apr 21, 2006

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 2

Medicare fee-for-service enrollment

Enrolled in FL

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shelly.thompson.1@21075.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.

• Im Sulzbacher Center for the Homeless, Inc

  • Federally Qualified Health Center (FQHC)
  • Jacksonville, FL
  • NPI 1710051354
  Medicare reassignment NPD
• Im Sulzbacher Center for the Homeless, Inc

  • Federally Qualified Health Center (FQHC)
  • Jacksonville, FL
  • NPI 1396369187

  Pediatrics

  NPD
• University of Florida Jacksonville Physicians, Inc.

  • Internal Medicine Physician
  • Jacksonville, FL
  • NPI 1144276452

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1821054560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 KING STREET",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322042410",
            "telephone_number": "904-760-4904",
            "fax_number": "904-760-4250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 KING ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322042410",
            "telephone_number": "904-760-4904",
            "fax_number": "904-760-4250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "SHELLY",
        "middle_name": "HOLDER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-21",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME0038917",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME38917",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "066208900",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0662089-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Natalee Paige Thompson, PA
• Paulette Purdy Thompson
• Reylius Thompson Jr.
• Robyn Thompson
• Ryan Bradley Thompson, MD
• Tangela Thompson
• Tanya Roxanne Thompson, LCSW
• Taylor Lee Thompson, PH.D
• Thaddeus Thompson, PT
• Thomas Zachary Thompson, M.D.

• Pediatrics Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.

Verify at the official NPI Registry.