Shanley Marie O'Brien, MD

Primary specialty

Rheumatology PhysicianTaxonomy code 207RR0500X

License

4301500409 Issued in MI

Practice address

4100 Park Forest Dr Ste 200
Traverse City, MI 49684-7306

Phone

(231) 600-7466

NPI assigned

Jun 14, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: sobrien231333@direct.saint-lukes.org

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.

• Novello Specialty Clinic PC

  • Multi-Specialty Clinic/Center
  • Traverse City, MI
  • NPI 1629716964
  Medicare reassignment

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

{
    "created_epoch": "1371168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668038400000",
    "number": "1104265933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 PARK FOREST DR STE 200",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847306",
            "telephone_number": "231-600-7466",
            "fax_number": "913-588-8182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 PARK FOREST DR STE 200",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847306",
            "telephone_number": "231-600-7466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BRIEN",
        "first_name": "SHANLEY",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-06-14",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": "MI",
            "license": "4301500409",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KS",
            "license": "9408209",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Noelle Gabrielle Nyquist
• Anya F Nyson, LMSW
• Abigail Marie O'Brien, FNP-C
• Andrew O'Brien, LMSW
• Jeannie O'Brien
• Andrew O'Donnel, PT/DPT
• Ann Clare O'Donnell, PSY.D.
• Neil Frederick O'Donnell, PH.D.
• Alissa A O'Hagan, M.D.
• Patrick James O'Hagan, PA-C

• Rheumatology Physician in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Rheumatology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2022; 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.