Individual provider Active NPI

Susanna Louise Shepard, PA-C

  • Physician Assistant
  • Jacksonville, FL
National Provider Identifier
1831819010
Registry record updated May 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9116315 Issued in FL
Practice address
1301 Palm Ave Ste 600
Jacksonville, FL 32207-8432
Phone
(904) 202-7300
Fax
(904) 202-2754
NPI assigned
Aug 30, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9116315 FL Primary

Addresses

Primary practice location

1301 Palm Ave Ste 600
Jacksonville, FL 32207-8432

Mailing address

PO Box 746654
Atlanta, GA 30374-6654
Phone (904) 202-2092

Other identifiers 1

IdentifierTypeStateIssuer
254016913MedicaidFL

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220922002581 FL Practitioner - Physician Assistant 4789069055 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Baptist MD Anderson Cancer Physicians IncGroup PAC ID 5991932063, 115 clinicians

Practice addresses (Care Compare)

1301 Palm Ave
Jacksonville, FL 32207-8432
Phone (904) 202-7300

14546 Old Saint Augustine Rd
Jacksonville, FL 32258-5469
Phone (904) 202-7300

Hospital & facility affiliations

  • Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088
  • Baptist Medical Center Beaches Hospital, Jacksonville Beach, FL, CCN 100117

Merit-based Incentive Payment System (MIPS)

Final score
85.84 of 100Reported as group
Quality
73.65
Promoting interoperability
100
Improvement activities
40
Cost
74.43

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9116315FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Cancer Specialists & Research Institute, LLC Hematology & Oncology CurrentSince Sep 6, 2022 Accepting new patients

Locations

1970 Golf St
Sarasota, FL 34236
Phone (941) 957-1000

1970 Golf St
Fl Cancer
Sarasota, FL 34236
Phone (941) 795-3780

Interoperability endpoints

  • Direct secure messaging: sshepard183584@baptisthealthsystemjacksonville.direct-ci.com

Organizations & group practices 2

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 2

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": "1661817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746489600000",
    "number": "1831819010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746654",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746654",
            "telephone_number": "904-202-2092",
            "fax_number": "904-376-4075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 PALM AVE STE 600",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078432",
            "telephone_number": "904-202-7300",
            "fax_number": "904-202-2754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEPARD",
        "first_name": "SUSANNA",
        "middle_name": "LOUISE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-30",
        "last_updated": "2025-05-06",
        "certification_date": "2025-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9116315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "254016913",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.