Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ian Thomas Shupe, MSPAS, PA-C, RTR

Individual provider Physician Assistant · NPI 1528632825

Ian Thomas Shupe, MSPAS, PA-C, RTR is a Physician Assistant in Medford, Oregon. Qualified in 2020, 6 years ago. Practices with North Idaho Dermatology Inc, a 15-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Oregon and Washington.

Years since qualifying
6
Licensed in
OR, WA
In the registry since
2021
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

842 E Main St
Medford, OR 97504-7155
Phone: (541) 618-5800
Fax: (541) 779-3027
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1910 E Barnett Rd Ste 104, Medford, OR 97504-8672 — (541) 956-4647

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA204375 (OR)
Physician Assistant Taxonomy 363A00000X · Licence PA.PA.61159625 (WA)

Record details

NPI number1528632825
Entity typeIndividual (Type 1)
GenderMale
Credentials MSPAS , PA-C , RTR
Sole proprietorNo
NPI enumeratedMay 19, 2021
Last updated in NPPESMay 19, 2021
Certification dateMay 19, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice North Idaho Dermatology Inc — 15 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Medford