Shane James Shepard, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A130296 Issued in CA

Practice address

124 N Brent St
Ventura, CA 93003-2810

Phone

(805) 641-9880

Fax

(805) 641-9890

NPI assigned

Jun 27, 2011

Last updated

Jul 27, 2021By 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 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Family Practice

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Providence Medical InstituteGroup PAC ID 5991609737, 303 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventist Health Simi Valley Hospital, Simi Valley, CA, CCN 050236

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: sshepard1424856@oc.providencedirect.org

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.

• Providence Medical Institute

  dba Providence Little Company of Mary Medical Institute

  • Family Medicine Physician
  • Torrance, CA
  • NPI 1417915760
  Medicare reassignment Care Compare group NPD
• Providence Medical Institute

  dba Providence Little Company of Mary Medical Institute

  • Family Medicine Physician
  • Torrance, CA
  • NPI 1235182569
  NPD
• Community Memorial Health System

  dba Community Memorial Hospital - Ventura

  • General Acute Care Hospital
  • Ventura, CA
  • NPI 1215903018
  NPD (past)
• Debra G Tennen, MD, a Professional Medical Corporation

  dba Agoura Hills Eye Care

  • Ophthalmology Physician
  • Agoura Hills, CA
  • NPI 1942355151
  NPD (past)
• Kpi Inc

  dba Kramers Pharmacy

  • Pharmacy
  • Agoura Hills, CA
  • NPI 1811040132
  NPD (past)

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

• Simi Valley Hospital and Health Care Services

  • General Acute Care Hospital
  • Simi Valley, CA
  • NPI 1063495190
  Care Compare affiliation

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

{
    "created_epoch": "1309132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627344000000",
    "number": "1962798066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 N BRENT ST",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930032810",
            "telephone_number": "805-641-9880",
            "fax_number": "805-641-9890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 N BRENT ST",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930032810",
            "telephone_number": "805-641-9880",
            "fax_number": "805-641-9890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEPARD",
        "first_name": "SHANE",
        "middle_name": "JAMES",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-27",
        "last_updated": "2021-07-27",
        "certification_date": "2021-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A130296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sshepard1424856@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "29525 Canwood St",
            "city": "Agoura Hills",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913014233",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Adam D Shellito, M.D.
• Jacqueline Lorraine Shellito, MD
• Taylor Shelton, LVN
• Jason Shenoi, MD
• Joseph Shenouda, DDS
• Veronica Marie Shepp
• Lawrence Mayer Sherf, PHARM D
• Andrew D Sherman, PT
• Harvey C. Shew, M.D.
• Richard W Shields

• Family Medicine Physician in Ventura, CA
• Providers in Ventura, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2021; 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.