Shannon Jean Roth, APRN, CNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

3280 Issued in MN

Practice address

400 E 3Rd St
Duluth, MN 55805-1951

Phone

(218) 786-8364

NPI assigned

Jan 3, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MN, WI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• CH Specialty Services MN PC

  • Internal Medicine Physician
  • Minneapolis, MN
  • NPI 1841999158
  Medicare reassignment NPD
• Curana Health of Minnesota PLLC

  • Internal Medicine Physician
  • Minneapolis, MN
  • NPI 1083365084

  Nurse Practitioner

  Medicare reassignment NPD
• Essentia Health Virginia, LLC

  dba Essentia Health Virginia

  • General Acute Care Hospital
  • Virginia, MN
  • NPI 1083617120
  Medicare reassignment NPD
• CH Specialty Services Wi SC

  • Internal Medicine Physician
  • Hartford, WI
  • NPI 1063115319
  Medicare reassignment NPD
• Curana Health of Wisconsin Inc

  • Internal Medicine Physician
  • Hartford, WI
  • NPI 1699407890
  Medicare reassignment NPD
• Essentia Health Virginia, LLC

  dba Essentia Health Babbitt Clinic

  • Multi-Specialty Clinic/Center
  • Babbitt, MN
  • NPI 1538107594
  NPD
• Duluth Graduate Medical Education Council Inc

  dba Duluth Family Medicine Clinic

  • Family Medicine Physician
  • Duluth, MN
  • NPI 1972585867
  NPD (past)
• Mayo Clinic

  • Clinical Medical Laboratory
  • Rochester, MN
  • NPI 1083249577
  NPD (past)
• The Duluth Clinic, LTD

  dba Essentia Health Duluth Clinic

  • Multi-Specialty Clinic/Center
  • Duluth, MN
  • NPI 1245278209
  NPD (past)

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

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540339200000",
    "number": "1144208976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 EAST THIRD STREET",
            "address_2": "MCL2CRED",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-3146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "SHANNON",
        "middle_name": "JEAN",
        "credential": "APRN, CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-03",
        "last_updated": "2018-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "3280",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "R1433638-5",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ND",
            "license": "R32669",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "408164100",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "19873",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rossow Counseling LLC
• Daniel Rossow
• Stephen Elsen Rostad, MD
• Vicki Rostollan, RN
• Meggie A Rosvold
• Joshua Jon Rother, M.D.
• Sandra Renee Rothleutner, RN
• Ava Rotterman
• Krista Lee Rouse, PHARM.D.
• Brenna Roush

• Family Nurse Practitioner in Duluth, MN
• Providers in Duluth, MN by specialty
• Family Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2018; 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.