Shannon Bock, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1528 Issued in CO

Practice address

403 Summit Blvd
Ste 201
Broomfield, CO 80021

Phone

(303) 429-6448

Fax

(303) 951-3701

NPI assigned

May 4, 2006

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

Medicare fee-for-service enrollment

Enrolled in CO

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, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Regeneration LLCGroup PAC ID 2264868900, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: milehighregenerativeandpaintherapy.shannonbock@144774.advancedmd-direct.com

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.

• Regeneration, LLC

  • Pain Medicine (Anesthesiology) Physician
  • Lakewood, CO
  • NPI 1427695881

  CO

  Medicare reassignment Care Compare group
• Centeno-Schultz, Inc

  • Interventional Pain Medicine Physician
  • Broomfield, CO
  • NPI 1003864398

  Physician Assistant

  NPD (past)
• Christopher J Centeno, MD, PC

  • Physician Assistant
  • Westminster, CO
  • NPI 1760416366
  NPD (past)

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589760000000",
    "number": "1083662225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12596 W BAYAUD AVE",
            "address_2": "STE 205",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802282018",
            "telephone_number": "720-713-1885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 SUMMIT BLVD",
            "address_2": "STE 201",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "80021",
            "telephone_number": "303-429-6448",
            "fax_number": "303-951-3701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOCK",
        "first_name": "SHANNON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-04",
        "last_updated": "2020-05-18",
        "certification_date": "2020-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "1528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jillene McMinn Black, OTR
• Laura Elizabeth Bland, PA-C
• Bethany Blankenheim, LPC, CACII
• Zoe Blosser
• Pamela Boaz, LCSW
• Bodies in Motion Chiropractic
• Body in Balance Chiropractic and Wellness, PLLC
• Bohman Orthodontics, PC
• Brian Christopher Bohman, DMD
• Lisa Boldini

• All providers in Broomfield, CO
• Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2020; 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.