Shanon Dione Bennett, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

001016 Issued in IA

Practice address

1731 W Ridgeway Ave Ste 100
Waterloo, IA 50701-4591

Phone

(319) 833-5888

Fax

(319) 833-5891

NPI assigned

Apr 5, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Shanon Dione Roelfs Former name

Medicare fee-for-service enrollment

Enrolled in IA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Iowa Physicians Clinic Medical FoundationGroup PAC ID 8729992318, 1,254 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Allen Hospital Hospital, Waterloo, IA, CCN 160110
• Waverly Health Center Hospital, Waverly, IA, CCN 161339

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sbennett231551@direct.unitypoint.org

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.

• Iowa Physicians Clinic Medical Foundation

  • General Practice Physician
  • West Des Moines, IA
  • NPI 1366425274
  Medicare reassignment Care Compare group NPD
• Allen Memorial Hospital Corporation

  • Women's Health Nurse Practitioner
  • Waterloo, IA
  • NPI 1891772927
  Medicare reassignment NPD (past)
• Allen Memorial Hospital Corporation

  • Emergency Medicine Physician
  • Waterloo, IA
  • NPI 1346292521

  Physician Assistant

  NPD
• Iowa Physicians Clinic Medical Foundation

  • Rural Health Clinic/Center
  • Kingsley, IA
  • NPI 1659263523

  Physician Assistant

  NPD
• St Luke'S Methodist Hospital

  • General Acute Care Hospital
  • Cedar Rapids, IA
  • NPI 1083708226
  NPD
• Floyd County Memorial Hospital Commission

  • Critical Access Hospital
  • Charles City, IA
  • NPI 1265402390
  NPD (past)
• Piedmont Urgent Care Center at Baxter Village LLC

  • Urgent Care Clinic/Center
  • Fort Mill, SC
  • NPI 1972590073
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Allen Memorial Hospital Corporation

  • General Acute Care Hospital
  • Waterloo, IA
  • NPI 1336231091
  Care Compare affiliation
• Waverly Health Center

  • Critical Access Hospital
  • Waverly, IA
  • NPI 1447299953
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1013979079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1731 W RIDGEWAY AVE STE 100",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507014591",
            "telephone_number": "319-833-5888",
            "fax_number": "319-833-5891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1731 W RIDGEWAY AVE STE 100",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507014591",
            "telephone_number": "319-833-5888",
            "fax_number": "319-833-5891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "SHANON",
        "middle_name": "DIONE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-05",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "001000136",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "001016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "970024832",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANON",
            "last_name": "ROELFS",
            "middle_name": "DIONE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bellmed Transportation LLC
• Jenna Beninga
• Benjamin R. Squires, D.D.S.
• Joseph Benjamin, DO
• Maggie Marie Bennett
• Bennhook PLLC
• Samuel Bernard, DPM
• Frederick Morgan Berneking, PHARM. D.
• Stephanie Berns, PHARMD
• Mitchel L. Bernstrom, M.D.

• Physician Assistant in Waterloo, IA
• Providers in Waterloo, IA by specialty
• Physician Assistant in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.