Brian Maurice Shefulsky, DO

Key facts

NPI

1992189997

Entity type

Individual (NPI type 1)

Primary specialty

General Practice Physician 208D00000X

License

2019041268 (MO)

Practice address

807 Owens Mill Rd
Stockton, MO 65785-8359

Phone

(417) 276-5500

Fax

(417) 876-3812

NPI assigned

Jul 20, 2015

Sex

Male

Sole proprietor

No

Organizations & group practices 4

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.

• Blue Medical LLC General Practice Physician · Nixa, MO · NPI 1124818729
  Medicare reassignment NPD Authorized official GENERAL PRACTICE · MO
• Cherry Health Center, LLC Physical Therapist · Springfield, MO · NPI 1770628620
  Medicare reassignment NPD MO
• DHHS PHS IHS Phoenix Area Clinic/Center · Winterhaven, CA · NPI 1265719918
  Medicare reassignment NPD TX
• Signify Health, LLC General Practice Physician · Dallas, TX · NPI 1689158487
  Medicare reassignment NPD GENERAL PRACTICE · MO

Medicare participation

Medicare fee-for-service enrollment

Enrolled (2 enrollments) in MO, TX

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Osteopathy

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 12, 2026.

{
    "created_epoch": "1437350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773273600000",
    "number": "1992189997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 S PARK ST",
            "city": "EL DORADO SPRINGS",
            "state": "MO",
            "postal_code": "647442037",
            "telephone_number": "417-876-2511",
            "fax_number": "417-876-3812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 OWENS MILL RD",
            "city": "STOCKTON",
            "state": "MO",
            "postal_code": "657858359",
            "telephone_number": "417-276-5500",
            "fax_number": "417-876-3812"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1317 S State Highway 32",
            "address_purpose": "LOCATION",
            "city": "El Dorado Springs",
            "state": "MO",
            "postal_code": "647442302",
            "country_code": "US",
            "telephone_number": "417-876-3333",
            "fax_number": "417-876-4509",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1401 S Park St",
            "address_purpose": "LOCATION",
            "city": "El Dorado Springs",
            "state": "MO",
            "postal_code": "647442037",
            "country_code": "US",
            "telephone_number": "417-876-2511",
            "fax_number": "417-876-3812",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHEFULSKY",
        "first_name": "BRIAN",
        "middle_name": "MAURICE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-20",
        "last_updated": "2026-03-12",
        "certification_date": "2026-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MO",
            "license": "2019041268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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