Active NPI
Shannon Dickinson, MS, RDN, LDN
- Registered Dietitian
- Vernon Hills, IL
National Provider Identifier
1063148260
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164008233
- Practice address
- 175 E Hawthorn Pkwy Ste 325
Vernon Hills, IL 60061-1460 - Phone
- (815) 451-6355
- NPI assigned
- Jul 28, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | IL | ||
| Registered Dietitian | 133V00000X | 164008233 | IL | Primary |
Addresses
Primary practice location
175 E Hawthorn Pkwy Ste 325
Vernon Hills, IL 60061-1460
Mailing address
71 Woodhills Bay Rd
Fox Lake, IL 60020-1564
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Simplepractice.com | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164008233 | IL | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710460800000",
"number": "1063148260",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "71 WOODHILLS BAY RD",
"city": "FOX LAKE",
"state": "IL",
"postal_code": "600201564"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "175 E HAWTHORN PKWY STE 325",
"city": "VERNON HILLS",
"state": "IL",
"postal_code": "600611460",
"telephone_number": "815-451-6355"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKINSON",
"first_name": "SHANNON",
"name_prefix": "Miss",
"credential": "MS, RDN, LDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-07-28",
"last_updated": "2024-03-15",
"certification_date": "2024-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": null,
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164008233",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Simplepractice.com",
"affiliation": "N",
"endpointDescription": "EMR",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "1862 Stockton Dr",
"city": "Hoffman Estates",
"state": "IL",
"country_code": "US",
"postal_code": "601696841",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Vernon Hills, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.