NPIMap

Individual provider Active NPI

Diana Scanlon, CNP

  • Nurse Practitioner
  • Shelby Township, MI
National Provider Identifier
1043651458
Registry record updated Oct 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704267416 Issued in MI
Practice address
45640 Schoenherr Rd
Suite B
Shelby Township, MI 48315-6033
Phone
(586) 247-4300
Fax
(586) 532-6496
NPI assigned
Jul 13, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 4704267416 MI
Nurse Practitioner 363L00000X 4704267416 MI Primary

Addresses

Primary practice location

45640 Schoenherr Rd
Suite B
Shelby Township, MI 48315-6033

Mailing address

45640 Schoenherr Rd
Suite B
Shelby Township, MI 48315-6033
Phone (586) 247-4300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131111001350 MI Practitioner - Nurse Practitioner 5890921316 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Clair Specialty Physicians PCGroup PAC ID 6204733256, 36 clinicians

Practice addresses (Care Compare)

45650 Schoenherr Rd
Shelby Township, MI 48315-6033
Phone (586) 286-7800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704267416MIMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Clair Specialty Physicians PC CurrentSince Jan 19, 2015 Accepting new patients
Idaho Nephrology Associates, L.L.C Past Accepting new patients
Colorado Springs Nephrology Past Accepting new patients

Locations

18001 E 10 Mile Rd
Roseville, MI 48066

23857 Greenfield Rd
Southfield, MI 48075
Phone (248) 569-6111

45650 Schoenherr Rd
Utica, MI 48315
Phone (586) 286-7800

45640 Schoenherr Rd
Ste B
Utica, MI 48315
Phone (586) 247-4300

Interoperability endpoints

  • Direct secure messaging: dscanlon369271@direct.hfhs.org
  • Direct secure messaging: dianascanlon@stclairspe.allscriptsdirect.net

Organizations & group practices 3

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1373673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445904000000",
    "number": "1043651458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45640 SCHOENHERR RD",
            "address_2": "SUITE B",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483156033",
            "telephone_number": "586-247-4300",
            "fax_number": "586-532-6496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45640 SCHOENHERR RD",
            "address_2": "SUITE B",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483156033",
            "telephone_number": "586-247-4300",
            "fax_number": "586-532-6496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCANLON",
        "first_name": "DIANA",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-13",
        "last_updated": "2015-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MI",
            "license": "4704267416",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704267416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby Township, MI

Sources for this page

Verify at the official NPI Registry.