Individual provider Active NPI

Shannon Mahoney

  • Physical Therapist
  • New York, NY
National Provider Identifier
1093208480
Registry record updated Jun 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
10 Columbus Cir
New York, NY 10019-1158
Phone
(212) 823-9730
NPI assigned
Jun 11, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

10 Columbus Cir
New York, NY 10019-1158

Mailing address

576 Broadhollow Rd
Melville, NY 11747-5002
Phone (631) 359-5800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180913002808 NY Practitioner - Physical Therapist in Private Practice 4284984139 Reassigns benefits to 1 organization
I20210805002100 MA Practitioner - Physical Therapist in Private Practice 4284984139 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Proex Physical Therapy LLCGroup PAC ID 0345212395, 166 clinicians

Practice addresses (Care Compare)

300 Tradecenter
Suite 1650
Woburn, MA 01801-1884
Phone (781) 935-2655

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Proex Physical Therapy, LLC CurrentSince Jul 12, 2021 Accepting new patients
Outreach Physical and Occupational Therapy & Speech Rehabilitation, PLLC Physical Therapist CurrentSince Apr 15, 2019 Accepting new patients
Proex Physical Therapy, LLC Physical Therapist CurrentSince Jul 12, 2021 Accepting new patients

Locations

10 High St
Ste 303
Boston, MA 02110
Phone (617) 542-6999

1150 Hall of Fame Ave
Ste 3
Springfield, MA 01105
Phone (413) 241-8900

600 Main St
Ste 5
Winchester, MA 01890
Phone (781) 277-7523

300 Tradecenter
Ste 1650
Woburn, MA 01801
Phone (781) 925-7643

3 Grace Ave
Ste 119
Great Neck, NY 11021
Phone (212) 842-0080

576 Broadhollow Rd
Melville, NY 11747

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1528675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528675200000",
    "number": "1093208480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "576 BROADHOLLOW RD",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "117475002",
            "telephone_number": "631-359-5800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 COLUMBUS CIR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191158",
            "telephone_number": "212-823-9730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHONEY",
        "first_name": "SHANNON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-11",
        "last_updated": "2018-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.