Shannon J Korth, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2250 Issued in NE

Practice address

4130 Pioneer Woods Dr Ste 1
Lincoln, NE 68506-7552

Phone

(402) 489-4700

Fax

(402) 489-5220

NPI assigned

Jun 14, 2018

Last updated

Jun 14, 2018By 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 1

Addresses

Other identifiers 1

Other names 1

• Shannon J Dunn Other name

Medicare fee-for-service enrollment

Enrolled in NE

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Prairie Orthopaedic & Plastic Surgery, P.C.

  • Orthopaedic Surgery Physician
  • Lincoln, NE
  • NPI 1639206147
  Medicare reassignment NPD
• Alivation Health, LLC

  • Psychiatry Physician
  • Lincoln, NE
  • NPI 1710917448
  Medicare reassignment
• Prairie Orthopaedic & Plastic Surgery, PC

  • Durable Medical Equipment & Medical Supplies
  • Lincoln, NE
  • NPI 1174243489
  NPD

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

{
    "created_epoch": "1528934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528934400000",
    "number": "1083107973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4130 PIONEER WOODS DR STE 1",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685067552",
            "telephone_number": "402-489-4700",
            "fax_number": "402-489-5220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4130 PIONEER WOODS DR STE 1",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685067552",
            "telephone_number": "402-489-4700",
            "fax_number": "402-489-5220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORTH",
        "first_name": "SHANNON",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-14",
        "last_updated": "2018-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "2250",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "2250",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "DUNN",
            "middle_name": "J",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Garrett S Kort, PT
• Jill N Korta, PT
• Allen N Korte, D.D.S.
• Alison Kortefay
• Christine Elizabeth Korth, PHARM.D.
• Tarnue Korvah
• Luis Kosa
• Linda Kose
• Poni K Kose
• Emmilie Kosiba

• Physician Assistant in Lincoln, NE
• Providers in Lincoln, NE by specialty
• Physician Assistant in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.