Coleen Shannon McDonald, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

25MP00708400 Issued in NJ

Practice address

780 Route 3
Clifton, NJ 07012-2328

Phone

(973) 777-6767

Fax

(973) 777-6745

NPI assigned

Jun 10, 2022

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

Medicare fee-for-service enrollment

Enrolled in NJ

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://mepic.hmhn.org/fhir/api/FHIR/R4/
• FHIR API: https://fhir4.healow.com/fhir/r4/IHJHBD

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.

• Hackensack Meridian Health Medical Group - Primary Care PC

  • Family Medicine Physician
  • Red Bank, NJ
  • NPI 1336203538
  Medicare reassignment NPD
• Hackensack Meridian Health Medical Group - Specialty Care PC

  • Surgical Critical Care Physician
  • Red Bank, NJ
  • NPI 1215989249
  Medicare reassignment
• Hackensack Meridian Health Medical Group - Specialty Care PC

  • Durable Medical Equipment & Medical Supplies
  • North Bergen, NJ
  • NPI 1215734199
  NPD
• Meridian Medical Group - Specialty Care, PC

  • Family Medicine Physician
  • Edgewater, NJ
  • NPI 1275362105
  NPD (past)
• PM Pediatrics of Livingston, PLLC

  • Urgent Care Clinic/Center
  • Livingston, NJ
  • NPI 1639430515
  NPD (past)

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

{
    "created_epoch": "1654819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655337600000",
    "number": "1023748357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 SCHIRRA DR",
            "city": "WANAQUE",
            "state": "NJ",
            "postal_code": "074651036",
            "telephone_number": "201-888-9824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 ROUTE 3",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070122328",
            "telephone_number": "973-777-6767",
            "fax_number": "973-777-6745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDONALD",
        "first_name": "COLEEN",
        "middle_name": "SHANNON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-10",
        "last_updated": "2022-06-16",
        "certification_date": "2022-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00708400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mba MD
• Michael R MC Master, P.A.
• MCB Professionals LLC
• Stephanie Christine McCulloch
• Josette McDaniel
• John Joseph McEvoy Jr., DPM
• Douglas Dean McGuire, DMD
• Tecoya McKelvey
• Nicole McLaughlin, MA/EDS
• Patricia McNerney, MA, OTR

• Physician Assistant in Clifton, NJ
• Providers in Clifton, NJ by specialty
• Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.