Kent Lyle Shippen, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-617 Issued in ID

Practice address

283 N 1St E
Driggs, ID 83422-5109

Phone

(208) 354-2302

Fax

(208) 354-8392

NPI assigned

Nov 6, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WY

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

Specialty

Physician Assistant

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Dermatology of Wyoming IncGroup PAC ID 7517253750, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Johns Medical Center Hospital, Jackson, WY, CCN 530015

Merit-based Incentive Payment System (MIPS)

Final score

83.46 of 100Reported as group

Quality

74.48

Improvement activities

40

Cost

78.9

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Advanced Dermatology of Wyoming, Inc

  • Dermatology Physician
  • Jackson, WY
  • NPI 1427408319
  Medicare reassignment Care Compare group
• Advanced Dermatology of Colorado, PC

  • Dermatology Physician
  • Fort Collins, CO
  • NPI 1710370648
  NPD (past)

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

• Teton County Hospital District

  dba St John's Medical Center/ or St John's Health

  • General Acute Care Hospital
  • Jackson, WY
  • NPI 1801835475
  Care Compare affiliation

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1942379003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "283 N 1ST E",
            "city": "DRIGGS",
            "state": "ID",
            "postal_code": "834225109",
            "telephone_number": "208-354-2302",
            "fax_number": "208-354-8392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "283 N 1ST E",
            "city": "DRIGGS",
            "state": "ID",
            "postal_code": "834225109",
            "telephone_number": "208-354-2302",
            "fax_number": "208-354-8392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIPPEN",
        "first_name": "KENT",
        "middle_name": "LYLE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-06",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lila Satterfield
• David A Saurman, PA-C
• Kevin Schaum
• Edward R Schauster, PARAMEDIC, FP-C
• Jacquelyn Rae Seguin, M.A., CCC-SLP
• Patricia Lee Snarr, LCSW
• Snowflakefish, LLC
• Elaine J Spang, PTA
• Kylie Spotts, DPT
• Michelle Norma Stone, PA

• Physician Assistant in Driggs, ID
• Providers in Driggs, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.
• 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.