Shannon Waller Davis, CNM

Primary specialty

Advanced Practice MidwifeTaxonomy code 367A00000X

License

2018010192 Issued in MO

Practice address

1031 Bellevue Ave Ste 400
Saint Louis, MO 63117-1858

Phone

(314) 977-7455

NPI assigned

Oct 21, 2015

Last updated

Feb 5, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Certified Nurse Midwife (CNM)

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Heartland Women's Healthcare LTDGroup PAC ID 1759270648, 29 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sparta Community Hospital Hospital, Sparta, IL, CCN 141349

Merit-based Incentive Payment System (MIPS)

Final score

82.36 of 100Reported as group

Quality

84.63

Improvement activities

40

Cost

55.93

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shannon.waller.davis.1@21608.direct.athenahealth.com
• Direct secure messaging: swallerdavis345007@direct-ehr-ssmhc.com

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.

• Heartland Women's Healthcare LTD

  • Obstetrics & Gynecology Physician
  • Marion, IL
  • NPI 1851307532
  Medicare reassignment Care Compare group NPD
• Heartland Women's Healthcare LTD

  • Clinical Medical Laboratory
  • Swansea, IL
  • NPI 1043852932
  NPD
• Heartland Women's Healthcare Il PC

  • Obstetrics & Gynecology Physician
  • Shiloh, IL
  • NPI 1568057131
  NPD (past)

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

• Sparta Community Hospital

  • Critical Access Hospital
  • Sparta, IL
  • NPI 1548216476
  Care Compare affiliation

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

{
    "created_epoch": "1445385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612483200000",
    "number": "1063884799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6420 CLAYTON RD STE 290",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631171811",
            "telephone_number": "314-781-8605",
            "fax_number": "314-781-2840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1031 BELLEVUE AVE STE 400",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631171858",
            "telephone_number": "314-977-7455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER DAVIS",
        "first_name": "SHANNON",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-21",
        "last_updated": "2021-02-05",
        "certification_date": "2021-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "MO",
            "license": "2018010192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1031 Bellevue Ave Ste 400",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631171858",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "swallerdavis345007@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "swallerdavis345007@direct-ehr-ssmhc.com",
            "address_1": "1031 Bellevue Ave Ste 400",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631171858",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• William Gregoy Wallace, RPH
• Marc Allan Wallach, DDS
• Samala Wallack, LPC
• Tanner Wallen, DO
• Karl Christian Wallenkampf, MD
• Debra Ann Waller-Lee, LCSW
• Kiersten Waller
• Natalie Waller
• Brandi Michelle Wallgren, M.A, CF-SLP
• Eileen Wallhermfechtel

• Advanced Practice Midwife in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Advanced Practice Midwife in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2021; 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.