Shannon Marie Malouf, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA22896 Issued in CA

Practice address

2201 Courage Dr
Fairfield, CA 94533-6733

Phone

(707) 784-2001

Fax

(707) 784-1494

NPI assigned

May 6, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Shannon Marie Swanberg Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment Care Compare group
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Redwood City, CA
  • NPI 1639252604
  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD

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

{
    "created_epoch": "1367798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641859200000",
    "number": "1063857977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 COURAGE DR",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945336733",
            "telephone_number": "707-784-2001",
            "fax_number": "707-784-1494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 COURAGE DR",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945336733",
            "telephone_number": "707-784-2001",
            "fax_number": "707-784-1494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALOUF",
        "first_name": "SHANNON",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-06",
        "last_updated": "2022-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA22896",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "2120 Professional Dr",
            "city": "Roseville",
            "state": "CA",
            "country_code": "US",
            "postal_code": "956613700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "SWANBERG",
            "middle_name": "MARIE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Harold Martin Malin Jr., PH.D., MA. MFT
• Laura Margaret Maline
• Anushua Farah Mall, MASTER
• Cristina Labao Mallari, RN
• Molly Ann Maloney, MASTER OF SOCIAL WOR
• Jessica Mamaril
• Maika Manalastas, DO
• Rodrigo H. Manalo, MD
• Michael Hangelo Manangan
• Benjamin Manayan

• Physician Assistant in Fairfield, CA
• Providers in Fairfield, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2022; 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.

Verify at the official NPI Registry.