Active NPI
Shannon Rose Riley
- Nurse Practitioner
- Brockton, MA
National Provider Identifier
1134714231
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- RN2301935
- Practice address
- 63 Main St
Brockton, MA 02301-4042 - Phone
- (508) 559-6699
- NPI assigned
- Mar 2, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN2301935 | MA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Nurse Practitioner | 363L00000X | RN2301935 | MA | Primary |
Addresses
Primary practice location
63 Main St
Brockton, MA 02301-4042
Mailing address
63 Main St
Brockton, MA 02301-4042
Phone (508) 559-6699
Other practice location 1
100 Washington Ave S
Minneapolis, MN 55401-2110
Phone (855) 705-5444
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220105001226 | MA | Practitioner - Nurse Practitioner | 4587055348 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN2301935 | MA | MD | Registered Nurse |
Interoperability endpoints
- sriley38297@direct.chppoc.masshiway.net
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1614643200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660262400000",
"number": "1134714231",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "63 MAIN ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023014042",
"telephone_number": "508-559-6699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "63 MAIN ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023014042",
"telephone_number": "508-559-6699"
}
],
"practiceLocations": [
{
"address_1": "100 Washington Ave S",
"address_purpose": "LOCATION",
"city": "Minneapolis",
"state": "MN",
"postal_code": "554012110",
"country_code": "US",
"telephone_number": "855-705-5444",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "RILEY",
"first_name": "SHANNON",
"middle_name": "ROSE",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-02",
"last_updated": "2022-08-12",
"certification_date": "2022-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MA",
"license": "RN2301935",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MA",
"license": "RN2301935",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 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.