Shannon R Staker, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

49110641205 Issued in UT

Practice address

210 W 300 N 75-3
Roosevelt, UT 84066

Phone

(435) 722-3971

Fax

(435) 722-6104

NPI assigned

Mar 24, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Pediatric Medicine

Education

University of Utah School of Medicine, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Uintah Basin Medical CenterGroup PAC ID 0244131944, 62 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Uintah Basin Medical Center

  • General Acute Care Hospital
  • Roosevelt, UT
  • NPI 1871556217
  Medicare reassignment Care Compare group NPD
• Uintah Basin Medical Center

  • Community/Retail Pharmacy
  • Vernal, UT
  • NPI 1285420414
  NPD
• Northeastern Utah Medical Group

  • Family Medicine Physician
  • Roosevelt, UT
  • NPI 1982664199

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1023078045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 W 300 N 75-3",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "84066",
            "telephone_number": "435-722-3971",
            "fax_number": "435-722-6104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 W 300 N 75-3",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "84066",
            "telephone_number": "435-722-3971",
            "fax_number": "435-722-6104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAKER",
        "first_name": "SHANNON",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-24",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "49110641205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D3849",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Timalee Vane Snow
• Kristin Solomon
• Cristine Clark Sorensen, RN
• Nichole Sorensen, FNP
• Gregory L Staker, MD
• Aaron Bagley Stevens, DO
• Anna Michelle Stevens
• Chet David Stevens
• Stewart Pharmacy, LLC
• Albert Simon Stone, PA-C

• Pediatrics Physician in Roosevelt, UT
• Providers in Roosevelt, UT by specialty
• Pediatrics Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.