Raymond Patrick Shupak, DMD, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

35670 Issued in TX

Practice address

1500 South Main Street JPS Hospital
Dept of Omfs
Fort Worth, TX 76104

Phone

(817) 702-5595

NPI assigned

Jun 22, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA, TX2 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 2

Specialty

Oral SurgeryAlso: Maxillofacial Surgery

Education

Univ of Pennsylvania School of Dental Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oral and Maxillofacial Network PLLCGroup PAC ID 2668498387, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• JPS Health Network Hospital, Fort Worth, TX, CCN 450039

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Oral & Maxillofacial Network, P.L.L.C.

  • Oral and Maxillofacial Surgery (Dentist)
  • Fort Worth, TX
  • NPI 1417170655
  Medicare reassignment Care Compare group
• Geisinger Clinic

  • Family Medicine Physician
  • Danville, PA
  • NPI 1366493868
  Medicare reassignment NPD
• Geisinger Clinic

  • Diagnostic Radiology Physician
  • Danville, PA
  • NPI 1558313023

  Oral and Maxillofacial Surgery

  NPD
• Geisinger Clinic

  • Family Medicine Physician
  • West Hazleton, PA
  • NPI 1902410673
  NPD
• Windber Hospital, Inc.

  • General Acute Care Hospital
  • Windber, PA
  • NPI 1275620536
  NPD (past)

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

• Tarrant County Hospital District

  • General Acute Care Hospital
  • Fort Worth, TX
  • NPI 1992753222
  Care Compare affiliation

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

{
    "created_epoch": "1308700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621814400000",
    "number": "1962798462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 SOUTH MAIN STREET JPS HOSPITAL",
            "address_2": "DEPT OF OMFS",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76104",
            "telephone_number": "817-702-5595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 SOUTH MAIN STREET JPS HOSPITAL",
            "address_2": "DEPT OF OMFS",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76104",
            "telephone_number": "817-702-5595"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3501 Terrace St",
            "address_purpose": "LOCATION",
            "city": "Pittsburgh",
            "state": "PA",
            "postal_code": "152132523",
            "country_code": "US",
            "telephone_number": "973-534-3775",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3501 Terrace Street",
            "address_2": "Suite 3189",
            "address_purpose": "LOCATION",
            "city": "Pittsburgh",
            "state": "PA",
            "postal_code": "15261",
            "country_code": "US",
            "telephone_number": "412-648-9100",
            "fax_number": "412-383-7862",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHUPAK",
        "first_name": "RAYMOND",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "DMD, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-22",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "PA",
            "license": "DS038719",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "TX",
            "license": "S4567",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "PA",
            "license": "MD461668",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "35670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1029564820001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Miloni Shroff, M.D.
• Susan Moses Shropshire, M.D.
• Karine Shufford
• Shujaat a Khan M D P a
• Karen Elisabeth Shults, LPC
• Twila May Shuquist, AGACNP-BC
• Larissa Shurley, LCDC
• Rebekah Shutter, LPC
• Staci Laine Shuttleworth, AUD
• Nadezhda Shvarts, FNP

• Oral and Maxillofacial Surgery (Dentist) in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Oral and Maxillofacial Surgery (Dentist) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 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.