DR. RAYMOND PATRICK SHUPAK DMD MD NPI 1962798462

NPI Information

  • NPI: 1962798462
  • Provider Name: DR. RAYMOND PATRICK SHUPAK, DMD, MD
  • Classification: Dentist - 1223S0112X
  • Specialization: Oral and Maxillofacial Surgery
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1500 SOUTH MAIN STREET JPS HOSPITAL
    DEPT OF OMFS
    FORT WORTH, TX
    ZIP 76104
  • Phone: (817) 702-5595

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NPI Details

DR. Raymond Patrick Shupak, DMD, MD is an oral and maxillofacial surgery dentist in Fort Worth, TX with 15 years of experience. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. DR. Raymond Patrick Shupak, DMD, MD NPI is 1962798462. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIV OF PENNSYLVANIA SCHOOL OF DENTAL MEDICINE
Graduation Year:2011

The provider's business location address is:

1500 SOUTH MAIN STREET JPS HOSPITAL
DEPT OF OMFS
FORT WORTH, TX
ZIP 76104
Phone: (817) 702-5595

The NPI 1962798462 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Established patient office or other outpatient visit, 20-29 minutes (HCPCS:99213)
  • Established patient office or other outpatient visit, 30-39 minutes (HCPCS:99214)
  • New patient office or other outpatient visit, 30-44 minutes (HCPCS:99203)
  • Melanoma (skin cancer) excision (HCPCS:NAN03)

The enumeration date for this NPI number is 6/22/2011 and was last updated on 5/24/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223S0112XDentistOral and Maxillofacial SurgeryDS038719PENNSYLVANIANo
2204E00000XOral & Maxillofacial SurgeryS4567TEXASNo
3204E00000XOral & Maxillofacial SurgeryMD461668PENNSYLVANIANo
41223S0112XDentistOral and Maxillofacial Surgery35670TEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11029564820001MEDICAIDPENNSYLVANIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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