NPIMap

Organization Active NPI

K.Shan Performance LLC.

  • Registered Dietitian
  • Bethlehem, PA
National Provider Identifier
1023637642
Registry record updated Apr 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Legal business name
K.SHAN PERFORMANCE LLC.
Practice address
1130 W Broad St Ste 101
Bethlehem, PA 18018-4926
Phone
(484) 554-9638
NPI assigned
Apr 14, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2020

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

Authorized official

Name
Kyle ShannonNPI 1871130591
Title
Managing Member/Owner
Phone
(484) 894-2631

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 133V00000X Primary
Metabolic Nutrition Registered DietitianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 133VN1006X
Obesity and Weight Management Nutrition Registered DietitianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 133VN1201X
Sports Dietetics Nutrition Registered DietitianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 133VN1501X

Addresses

Primary practice location

1130 W Broad St Ste 101
Bethlehem, PA 18018-4926

Mailing address

1130 W Broad St Ste 101
Bethlehem, PA 18018-4926
Phone (484) 554-9638

Other names 1

  • KSP Fitness Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://secure.gethealthie.com/users/sign_in?target_url=/

National Provider Directory

National Provider Directory

Locations

1130 W Broad St
#101
Bethlehem, PA 18018
Phone (484) 554-9638

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1586822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586822400000",
    "number": "1023637642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 W BROAD ST STE 101",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180184926",
            "telephone_number": "484-554-9638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 W BROAD ST STE 101",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180184926",
            "telephone_number": "484-554-9638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "K.SHAN PERFORMANCE LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-14",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A",
        "authorized_official_last_name": "SHANNON",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "MANAGING MEMBER/OWNER",
        "authorized_official_telephone_number": "484-894-2631"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "133VN1006X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1201X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Obesity and Weight Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1501X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Sports Dietetics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://secure.gethealthie.com/users/sign_in?target_url=/",
            "affiliation": "N",
            "endpointDescription": "Dietician based software which is HIPPA compliance and safe",
            "address_1": "1130 W Broad St Ste 101",
            "city": "Bethlehem",
            "state": "PA",
            "country_code": "US",
            "postal_code": "180184926",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "KSP Fitness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bethlehem, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.