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

Shane James Shepard, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1962798066

Shane James Shepard, MD is a Family Practice in Ventura, California. Qualified in 2011, 15 years ago. Practices with Providence Medical Institute, a 336-clinician group, accepts Medicare assignment and offers telehealth. Licensed in California.

Years since qualifying
15
Licensed in
CA
In the registry since
2011
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

124 N Brent St
Ventura, CA 93003-2810
Phone: (805) 641-9880
Fax: (805) 641-9890
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence A130296 (CA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1962798066
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 27, 2011
Last updated in NPPESJuly 27, 2021
Certification dateJuly 27, 2021
Mailing address124 N Brent St, Ventura, CA 93003-2810

Medicare enrollment

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

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2011 (15 years in practice)
Group practice Providence Medical Institute — 336 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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