Maryellen Kathryn Shannon, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

AZ19717 Issued in AZ

Practice address

6 Hughes
Ste 100
Irvine, CA 92618-2059

Phone

(949) 680-1880

Fax

(949) 680-1881

NPI assigned

Aug 27, 2006

Last updated

Jan 2, 2015By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• South Coast Medical Center for New Medicine,.Inc

  dba Center For New Medicine

  • General Practice Physician
  • Irvine, CA
  • NPI 1891939351
  Medicare reassignment NPD

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

{
    "created_epoch": "1156636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420156800000",
    "number": "1033227483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 HUGHES",
            "address_2": "STE 100",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926182059",
            "telephone_number": "949-680-1880",
            "fax_number": "949-680-1881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 HUGHES",
            "address_2": "STE 100",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926182059",
            "telephone_number": "949-680-1880",
            "fax_number": "949-680-1881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "MARYELLEN",
        "middle_name": "KATHRYN",
        "name_prefix": "Ms.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-27",
        "last_updated": "2015-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "AZ",
            "license": "AZ19717",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04886",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shalini Shah, M.D., Inc
• Kiyanoosh Shamlou, PHD
• Barbara Shang, M.D.
• Jennifer Shang
• R. Meleah Shank
• Shape 4 Families Inc.
• Toni Shapiro, LCSW, CMC
• Emily Shappell
• Sharif Dental Corp
• Alex R. Sharifian, DDS

• Obstetrics & Gynecology Physician in Irvine, CA
• Providers in Irvine, CA by specialty
• Obstetrics & Gynecology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2015; 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.