Shannon Bowen, APRN
Individual provider Active NPI Nurse Practitioner · Crestview Hills, KY
NPI 1104463793 · NPPES record last updated Dec 13, 2019
Key facts
- NPI
- 1104463793
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 3014133 (KY)
- Practice address
- 651 Centre View Boulevard
Crestview Hills, KY 41017-5423 - Phone
- (859) 344-1900
- Fax
- (859) 344-4632
- NPI assigned
- Dec 3, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 11
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Summit Medical Group Inc
Practice addresses (Care Compare)
651 Centre View Boulvard
Crestview Hills, KY 41017-5419
Phone (859) 331-6466
Hospital & facility affiliations
- St Elizabeth Edgewood
- St Elizabeth Dearborn Hospital
- St Elizabeth Ft Thomas
- St Elizabeth Florence
- St Elizabeth Grant
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.01 of 100
- Quality
- 86.02
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200115002725 | KY | Practitioner - Nurse Practitioner | 2961837125 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1115588 | KY | MD | Nurse Practitioner |
| 3014133 | KY | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summit Medical Group, Inc. | Current |
Accepting new patients | |
| Summit Medical Group, Inc | Nurse Practitioner | Current |
Accepting new patients |
Locations
651 Centre View Blvd
Crestview Hills, KY 41017
Phone (859) 341-6660
1980 Litton Ln
Hebron, KY 41048
Phone (859) 334-8700
300 Barnes Rd
Williamstown, KY 41097
Phone (859) 824-8217
Interoperability endpoints
- sbowen299502@direct-prd.stelizabeth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 1115588 | KY | |
| Nurse Practitioner | 363L00000X | 3014133 | KY | Yes |
Addresses
Primary practice location
651 Centre View Boulevard
Crestview Hills, KY 41017-5423
Mailing address
PO Box 635283
Cincinnati, OH 45263-5283
Phone (859) 344-1900
Other providers in Crestview Hills, KY
- Valery R Bodziony
- Bogner & Carr, Inc.
- Christopher F Bolling
- Eric L Bosley
- Michelle M Bosse
- Brace Shop & Prosthetic Services Inc
- Emily Nichole Bray
- Grant Hamilton Breazeale
- Stephanie Bright
- Pamela Brock
All providers in Crestview Hills, KY · Nurse Practitioner in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 13, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.