Active NPI
John Randall Shepherd, M.D.
- Family Medicine Physician
- Ina, IL
National Provider Identifier
1992956510
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036095033
- Practice address
- 251 N. Illinois Hwy. 37
Big Muddy Correctional Center
Ina, IL 62846 - Phone
- (618) 437-5300
- NPI assigned
- Oct 1, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036095033 | IL | Primary |
Addresses
Primary practice location
251 N. Illinois Hwy. 37
Big Muddy Correctional Center
Ina, IL 62846
Mailing address
5389 Pershing Ave
Unit C
Saint Louis, MO 63112-1758
Phone (314) 361-8143
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150604002932 | MO | Order and Referring Only - Family Practice | 7214258029 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jefferson County | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Public Health or Welfare Agency
- Mount Vernon, IL
- NPI 1235253907
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222819200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222819200000",
"number": "1992956510",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5389 PERSHING AVE",
"address_2": "UNIT C",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631121758",
"telephone_number": "314-361-8143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "251 N. ILLINOIS HWY. 37",
"address_2": "BIG MUDDY CORRECTIONAL CENTER",
"city": "INA",
"state": "IL",
"postal_code": "62846",
"telephone_number": "618-437-5300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEPHERD",
"first_name": "JOHN",
"middle_name": "RANDALL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-10-01",
"last_updated": "2008-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036095033",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ina, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2008; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.