Shannon Lynn Watts, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

C0007101 Issued in MD

Practice address

5401 Old Court Rd
Randallstown, MD 21133-5103

Phone

(410) 521-2200

NPI assigned

Jun 17, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Shannon Lynn Wood Former name

Medicare fee-for-service enrollment

Enrolled in MD

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, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northwest Hospital Center IncGroup PAC ID 6204739352, 90 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northwest Hospital Center Hospital, Randallstown, MD, CCN 210040

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.

• Northwest Hospital Center, Inc

  • Hospitalist Physician
  • Randallstown, MD
  • NPI 1508961988

  Physician Assistant

  Medicare reassignment Care Compare group NPD

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

• Northwest Hospital Center, Inc.

  • General Acute Care Hospital
  • Randallstown, MD
  • NPI 1487695888
  Care Compare affiliation

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

{
    "created_epoch": "1560729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560729600000",
    "number": "1023678620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1464 ROCKRIDGE RD",
            "city": "JARRETTSVILLE",
            "state": "MD",
            "postal_code": "210841302",
            "telephone_number": "443-981-9539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5401 OLD COURT RD",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211335103",
            "telephone_number": "410-521-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATTS",
        "first_name": "SHANNON",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-17",
        "last_updated": "2019-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C0007101",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MD",
            "license": "C0007101",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0007101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "WOOD",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Judy Lynn Waltz, MSN, APRN, AGCNS-BC
• Jack Laurence Wapner, M.D.
• Julie Anne Warehime, OTR
• Robyn Thomas Washington
• Dalila Watson
• Gracious Weah, CNA-DT
• Jessica Audrey Webster Medalis, CRNA
• Gary H Weiss, D.D.S.
• Wellpharma LLC
• Wellpharma LLC

• Physician Assistant in Randallstown, MD
• Providers in Randallstown, MD by specialty
• Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2019; 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.