Shannon Ballard Callaway, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA2022-0043 Issued in NM

Practice address

300 W Country Club Rd Ste 130
Roswell, NM 88201-5249

Phone

(575) 625-2669

Fax

(575) 624-4632

NPI assigned

Jun 9, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Ms. Shannon Callaway Vickers Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NM

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 1

Merit-based Incentive Payment System (MIPS)

Final score

89.53 of 100Reported as apm

Quality

79.07

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shannon.callaway.2@1610.direct.athenahealth.com

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.

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730764800000",
    "number": "1144224932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W COUNTRY CLUB RD STE 130",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882015249",
            "telephone_number": "575-625-2669",
            "fax_number": "575-624-4632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W COUNTRY CLUB RD STE 130",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882015249",
            "telephone_number": "575-625-2669",
            "fax_number": "575-624-4632"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 W Country Club Rd Ste 201",
            "address_purpose": "LOCATION",
            "city": "Roswell",
            "state": "NM",
            "postal_code": "882015225",
            "country_code": "US",
            "telephone_number": "575-627-0535",
            "fax_number": "575-627-5590",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CALLAWAY",
        "first_name": "SHANNON",
        "middle_name": "BALLARD",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-09",
        "last_updated": "2024-11-05",
        "certification_date": "2024-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "COO2607",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NM",
            "license": "PA2022-0043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "shannon.callaway.2@1610.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR Direct Address",
            "address_1": "300 W Country Club Rd Ste 130",
            "city": "Roswell",
            "state": "NM",
            "country_code": "US",
            "postal_code": "882015249",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "VICKERS",
            "middle_name": "CALLAWAY",
            "prefix": "MS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• John D Caggiano, M.D.
• Nida C Cala, P.T.
• Marissa Calderon
• Raul Calderon, OTR/L
• Mary Caldwell
• Jana Elaine Camp
• Jennifer Campbell
• Jennifer Leigh Campbell, M.S. CCC-SLP
• Ashley Ruth Canard, M.S. SLP-CFY
• Mary Angela Cancino Gallagher, OTR/L

• Medical Physician Assistant in Roswell, NM
• Providers in Roswell, NM by specialty
• Medical Physician Assistant in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.