Active NPI
Shannon Green, HHA
- Personal Care Attendant
- Utica, NY
National Provider Identifier
1073256616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Personal Care Attendant
- Practice address
- 1216 Gray Ave
Utica, NY 13502-3959 - Phone
- (315) 864-0416
- NPI assigned
- Apr 20, 2022
- Reactivated
- Dec 24, 2024
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Basic Emergency Medical Technician | 146N00000X | |||
| Personal Care Attendant | 3747P1801X | Primary |
Addresses
Primary practice location
1216 Gray Ave
Utica, NY 13502-3959
Mailing address
1216 Gray Ave
Utica, NY 13502-3959
Phone (315) 864-0416
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073256616 | Medicaid | NY | |
| 13502 | Medicaid | NY |
Other names 1
- Shannon Green
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shannon Green RCM Management | Current | 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.
-
- In Home Supportive Care Agency
- Utica, NY
- NPI 1861249963
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1650412800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1780704000000",
"number": "1073256616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1216 GRAY AVE",
"city": "UTICA",
"state": "NY",
"postal_code": "135023959",
"telephone_number": "315-864-0416"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1216 GRAY AVE",
"city": "UTICA",
"state": "NY",
"postal_code": "135023959",
"telephone_number": "315-864-0416"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "SHANNON",
"credential": "HHA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-04-20",
"last_updated": "2026-06-06",
"certification_date": "2026-06-06",
"deactivation_date": "2023-01-01",
"reactivation_date": "2024-12-24",
"status": "A"
},
"taxonomies": [
{
"code": "146N00000X",
"taxonomy_group": "",
"desc": "Emergency Medical Technician, Basic",
"state": null,
"license": null,
"primary": false
},
{
"code": "3747P1801X",
"taxonomy_group": "",
"desc": "Technician, Personal Care Attendant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1073256616",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "13502",
"state": "NY"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SHANNON",
"last_name": "GREEN",
"credential": "MR GREEN",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Utica, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.