DR. SKYLER SHANE SHIPPEN (M.D.) – Family Medicine Physician, NPI 1194174995

DR. SKYLER SHANE SHIPPEN (M.D.) is a healthcare provider. based in Pocatello, Idaho. specializing in FAMILY PRACTICE. They hold the professional credentials M.D.. They hold a License No. MRM-1552 (ID). The NPI Number for DR. SKYLER SHANE SHIPPEN (M.D.) is 1194174995

Main info

Male
10 Years Of Experience
Accepts Medicare Assignment
Name
DR. SKYLER SHANE SHIPPEN (M.D.)
NPI
1194174995
Phone
(208) 282-4696
Address
465 MEMORIAL DR
Enumeration Date
13 June 2016
Last Update Date
13 June 2016

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
2016 (10 years ago)
PAC ID
3173815180
Group Practice PAC ID
1052217478
Professional Enrollment ID
I20180816000317
Address ID
ID833015819TW775XXWXXX500
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience32
Completeness75
Years active:9State licenses:1Digital endpointsOther names

969 FAMILY PRACTICE in ID

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Provider Addresses for DR. SKYLER SHANE SHIPPEN (M.D.)

  • Family Medicine/Dental Sciences, 465, Memorial Drive, Pocatello, Bannock County, Idaho, 83201, United States

    POCATELLO, ID 832014008

    Phone: (208) 282-4696

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2018-08-16

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20180816000317IFamily PracticeIDTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99214Established patient office or other outpatient visit, 30-39 minutes189124$0
99213Established patient office or other outpatient visit, 20-29 minutes7672$0
99204New patient office or other outpatient visit, 45-59 minutes1313$0
99203New patient office or other outpatient visit, 30-44 minutes1212$0
View full utilization report →

Insurance plans in this area (ZIP 83201)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1052217478View full group profile
NameSpecialtyState
Certified Registered Nurse Anesthetist (Crna)VA
Certified Registered Nurse Anesthetist (Crna)ID
Clinical PsychologistND
A N E S T H E S I O L O G YID
-UT
Diagnostic RadiologyOR
Physician AssistantID
Family PracticeID
O B S T E T R I C S/ G Y N E C O L O G YID
Nurse PractitionerID

Reviews

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Frequently asked questions

What is the 10-digit NPI for DR. SKYLER SHANE SHIPPEN (M.D.)?
DR. SKYLER SHANE SHIPPEN (M.D.) — NPI 1194174995 — is the standard way to identify this listing.
Does the file indicate DR. SKYLER SHANE SHIPPEN (M.D.) is practicing under active NPI?
Directory data currently reports DR. SKYLER SHANE SHIPPEN (M.D.) as active.
What is DR. SKYLER SHANE SHIPPEN (M.D.) best known for clinically?
Directory data describes DR. SKYLER SHANE SHIPPEN (M.D.) with Family Medicine Physician. Clinical services aligned with this taxonomy classification.
What area does DR. SKYLER SHANE SHIPPEN (M.D.) serve?
DR. SKYLER SHANE SHIPPEN (M.D.)'s listing highlights Pocatello, Idaho; more addresses can appear in NPPES.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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