NPIMap

Organization Active NPI

Shannondell, Inc.

Doing business as Shannondell Health

  • Geriatric Medicine (Internal Medicine) Physician
  • Audubon, PA
National Provider Identifier
1043927338
Registry record updated Mar 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
Legal business name
SHANNONDELL, INC.
Doing business as
Shannondell Health
Practice address
5000 Shannondell Dr
Audubon, PA 19403-5684
Phone
(610) 728-5400
NPI assigned
Nov 4, 2022
Last updated
Mar 10, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SHANNONDELL, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 10, 2023

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

Authorized official

Name
Mr. Daniel Freed
Title
Vice President of Health Services
Phone
(610) 728-5400

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QG0300X
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0300X Primary

Addresses

Primary practice location

5000 Shannondell Dr
Audubon, PA 19403-5684

Mailing address

5000 Shannondell Dr
Audubon, PA 19403-5684

Other names 1

  • Shannondell Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130627000670 PA Part B Supplier - Clinic/Group Practice 9032141189 Receives reassigned benefits from 22 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Audubon, PA

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Shannondell Inc3 organizations share this tax ID, including this one
Part of
Shannondell Inc

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1667520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678406400000",
    "number": "1043927338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 SHANNONDELL DR",
            "city": "AUDUBON",
            "state": "PA",
            "postal_code": "194035684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 SHANNONDELL DR",
            "city": "AUDUBON",
            "state": "PA",
            "postal_code": "194035684",
            "telephone_number": "610-728-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANNONDELL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHANNONDELL, INC.",
        "enumeration_date": "2022-11-04",
        "last_updated": "2023-03-10",
        "certification_date": "2023-03-09",
        "status": "A",
        "authorized_official_last_name": "FREED",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "VICE PRESIDENT OF HEALTH SERVICES",
        "authorized_official_telephone_number": "610-728-5400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shannondell Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shannondell Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Audubon, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.