Djaninn Mae Shannon McKibben, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PAC0687 Issued in ND

Practice address

222 N 7TH St
Bismarck, ND 58501-4436

Phone

(701) 323-6000

NPI assigned

Jun 19, 2014

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 names 1

• Djaninn Mae Shannon Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in ND

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, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sanford BismarckGroup PAC ID 9739098575, 562 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sanford Medical Center Bismarck Hospital, Bismarck, ND, CCN 350015

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Sanford Bismarck

  • Multi-Specialty Clinic/Center
  • Bismarck, ND
  • NPI 1811941172
  Medicare reassignment Care Compare group NPD
• Mid Dakota Clinic, Inc.

  • Clinic/Center
  • Bismarck, ND
  • NPI 1275587826
  Medicare reassignment

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

• Sanford Bismarck

  • General Acute Care Hospital
  • Bismarck, ND
  • NPI 1538245634
  Care Compare affiliation

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

{
    "created_epoch": "1403136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677024000000",
    "number": "1023422805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074",
            "telephone_number": "605-328-6585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 N 7TH ST",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585014436",
            "telephone_number": "701-323-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1011 Boundary St NW",
            "address_purpose": "LOCATION",
            "city": "Mandan",
            "state": "ND",
            "postal_code": "585541608",
            "country_code": "US",
            "telephone_number": "701-323-6000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1021 N 26th St",
            "address_purpose": "LOCATION",
            "city": "Bismarck",
            "state": "ND",
            "postal_code": "585013109",
            "country_code": "US",
            "telephone_number": "701-323-6000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3500 21st St SE",
            "address_purpose": "LOCATION",
            "city": "Mandan",
            "state": "ND",
            "postal_code": "585541341",
            "country_code": "US",
            "telephone_number": "701-323-6000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "301 Lorrain Dr",
            "address_purpose": "LOCATION",
            "city": "Bismarck",
            "state": "ND",
            "postal_code": "585030311",
            "country_code": "US",
            "telephone_number": "701-323-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCKIBBEN",
        "first_name": "DJANINN MAE",
        "middle_name": "SHANNON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-19",
        "last_updated": "2023-02-22",
        "certification_date": "2022-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "11613",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "PAC0687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dmckibben12235728@direct.sanfordhealth.org",
            "affiliation": "N",
            "address_1": "1021 N 26th St",
            "city": "Bismarck",
            "state": "ND",
            "country_code": "US",
            "postal_code": "585013109",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "DJANINN",
            "last_name": "SHANNON",
            "middle_name": "MAE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Matthew Ryan McGlasson, PHARMD.
• Kelly McGrady, NP
• Amanda Rae McGrath, MS, SLP
• Geri A McIntee, NP-C
• Michael J McIntee, MD
• Michelle L McKim
• Crystal McLaughlin
• Carol Grace McLean, MSCCCSLP
• Jessica McLindsay, AU.D.
• Grace Ann McMicken, PTA

• Physician Assistant in Bismarck, ND
• Providers in Bismarck, ND by specialty
• Physician Assistant in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2023; 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.