Active NPI
Shannon L Nolan, PA-C
- Surgical Physician Assistant
- Omaha, NE
National Provider Identifier
1063430841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 1206
- Practice address
- 13616 California St
Ste 100
Omaha, NE 68154-5335 - Phone
- (402) 496-0404
- Fax
- (402) 496-0517
- NPI assigned
- Jul 18, 2006
- Last updated
- Jan 28, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 1206 | NE | Primary |
Addresses
Primary practice location
13616 California St
Ste 100
Omaha, NE 68154-5335
Mailing address
13616 California St
Ste 100
Omaha, NE 68154-5335
Phone (402) 496-0404
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 279884 | Other | NE | MEDICARE |
| 37976 | Other | NE | BCBS |
| P00337631 | Other | NE | RR MEDICARE |
| 47081304012 | Medicaid | NE | |
| 68154A022 | Other | NE | TRICARE |
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1206 | NE | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cardiothoracic & Vascular Surgery, PA | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Pensacola, FL
- NPI 1306047873
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233100800000",
"number": "1063430841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13616 CALIFORNIA ST",
"address_2": "STE 100",
"city": "OMAHA",
"state": "NE",
"postal_code": "681545335",
"telephone_number": "402-496-0404",
"fax_number": "402-496-0517"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13616 CALIFORNIA ST",
"address_2": "STE 100",
"city": "OMAHA",
"state": "NE",
"postal_code": "681545335",
"telephone_number": "402-496-0404",
"fax_number": "402-496-0517"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOLAN",
"first_name": "SHANNON",
"middle_name": "L",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-18",
"last_updated": "2009-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "NE",
"license": "1206",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "279884",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "37976",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00337631",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47081304012",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "68154A022",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.