Active NPI
Shannon Grove, RDN
- Registered Dietitian
- Greenwood, IN
National Provider Identifier
1093220790
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 952699
- Practice address
- 500 Polk St Ste 24
Greenwood, IN 46143-1638 - Phone
- (317) 796-5740
- NPI assigned
- Dec 5, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 952699 | IN | Primary |
Addresses
Primary practice location
500 Polk St Ste 24
Greenwood, IN 46143-1638
Mailing address
241 E Brunswick Ave
Indianapolis, IN 46227-2047
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 952699 | IN | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512432000000",
"number": "1093220790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "241 E BRUNSWICK AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462272047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 POLK ST STE 24",
"city": "GREENWOOD",
"state": "IN",
"postal_code": "461431638",
"telephone_number": "317-796-5740"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROVE",
"first_name": "SHANNON",
"credential": "RDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-12-05",
"last_updated": "2017-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IN",
"license": "952699",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenwood, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.