Active NPI
Randall J Shannon, MD
- Anatomic Pathology & Clinical Pathology Physician
- Butte, MT
National Provider Identifier
1043327562
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 8104
- Practice address
- 400 S Clark St
Butte, MT 59701-2328 - Phone
- (406) 782-7442
- NPI assigned
- Aug 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 8104 | MT | Primary |
Addresses
Primary practice location
400 S Clark St
Butte, MT 59701-2328
Mailing address
PO Box 4108
Butte, MT 59702-4108
Phone (406) 782-7442
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 019994 | Medicaid | MT | |
| 011991 | Other | MT | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Pathology
- Education
- Indiana University School of Medicine, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
400 S Clark St
Butte, MT 59701-2328
Phone (406) 782-7442
Hospital & facility affiliations
- St James Hospital
- Community Hospital of Anaconda
- University of Michigan Health System
- St. Patrick Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 96.47 of 100
- Quality
- 92.94
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8104 | MT | MD | Anatomic Pathology & Clinical Pathology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Butte Pathology LLC | Anatomic Pathology & Clinical Pathology | Current | Accepting new patients |
| St. James Healthcare | Current | Accepting new patients |
Locations
400 S Clark St
Butte, MT 59701
Phone (406) 495-7260
5700 Southwyck Blvd
Toledo, OH 43614
Organizations & group practices 2
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.
-
- Anatomic Pathology & Clinical Pathology Physician
- Butte, MT
- NPI 1861509382
-
- Clinic/Center
- Butte, MT
- NPI 1356687198
Hospital & facility affiliations 14
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Critical Access Hospital
- Anaconda, MT
- NPI 1205887924
-
- Pediatric Adolescent Medicine Physician
- Anaconda, MT
- NPI 1992838288
Hospital
-
- General Acute Care Hospital
- Missoula, MT
- NPI 1023032588
-
- Anatomic Pathology & Clinical Pathology Physician
- Missoula, MT
- NPI 1366185928
Hospital
-
- Psychiatric Hospital Unit
- Missoula, MT
- NPI 1619058302
-
- General Acute Care Hospital
- Butte, MT
- NPI 1528037215
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1200268800000",
"number": "1043327562",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4108",
"city": "BUTTE",
"state": "MT",
"postal_code": "597024108",
"telephone_number": "406-782-7442"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 S CLARK ST",
"city": "BUTTE",
"state": "MT",
"postal_code": "597012328",
"telephone_number": "406-782-7442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANNON",
"first_name": "RANDALL",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-23",
"last_updated": "2008-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "MT",
"license": "8104",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "019994",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "011991",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Butte, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2008; 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.