Individual provider Active NPI

Shannon B Palmer, AUD, PHD

  • Audiologist
  • Mt Pleasant, MI
National Provider Identifier
1023395886
Registry record updated Nov 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
1601000601 Issued in MI
Practice address
1101 Health Professions BRG
Mt Pleasant, MI 48859-0001
Phone
(989) 774-3904
Fax
(989) 774-1891
NPI assigned
Nov 8, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 1601000601 MI Primary

Addresses

Primary practice location

1101 Health Professions BRG
Mt Pleasant, MI 48859-0001

Mailing address

1101 Health Professions BRG
Mt Pleasant, MI 48859-0001
Phone (989) 774-3904

Other identifiers 2

IdentifierTypeStateIssuer
1601000601OtherMISTATE LICENSE
14030014OtherMIASHA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120103000476 MI Practitioner - Qualified Audiologist 3779759352 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
1601000601MIMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Central Michigan University Current Accepting new patients

Locations

1101 Health Professions
Mount Pleasant, MI 48859
Phone (989) 774-2597

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1320710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320710400000",
    "number": "1023395886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 HEALTH PROFESSIONS BRG",
            "city": "MT PLEASANT",
            "state": "MI",
            "postal_code": "488590001",
            "telephone_number": "989-774-3904",
            "fax_number": "989-774-1891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 HEALTH PROFESSIONS BRG",
            "city": "MT PLEASANT",
            "state": "MI",
            "postal_code": "488590001",
            "telephone_number": "989-774-3904",
            "fax_number": "989-774-1891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALMER",
        "first_name": "SHANNON",
        "middle_name": "B",
        "credential": "AUD, PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-08",
        "last_updated": "2011-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "MI",
            "license": "1601000601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "1601000601",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASHA",
            "identifier": "14030014",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mt Pleasant, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.