NPIMap

Individual provider Active NPI

Nicholle Elizabeth Shannon, CRNP

  • Nurse Practitioner
  • Center Valley, PA
National Provider Identifier
1164094967
Registry record updated Dec 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN673311 Issued in PA
Practice address
5445 Lanark Rd FL 3
Center Valley, PA 18034-8694
Phone
(484) 526-7300
Fax
(866) 449-5832
NPI assigned
Jul 13, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN673311 PA Primary

Addresses

Primary practice location

5445 Lanark Rd FL 3
Center Valley, PA 18034-8694

Mailing address

5445 Lanark Rd FL 3
Center Valley, PA 18034-8694
Phone (484) 526-7300

Other names 1

  • Nicholle Elizabeth Daley Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220228000990 PA Practitioner - Nurse Practitioner 5991199416 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Lukes Physician Group IncGroup PAC ID 6709798333, 2,161 clinicians

Practice addresses (Care Compare)

5445 Lanark Rd 3Rd FL
St Lukes Center for Diabetes and Endocrinol
Center Valey, PA 18034-0000
Phone (484) 526-7300

Hospital & facility affiliations

  • St Lukes Hospital Hospital, Bethlehem, PA, CCN 390049
  • St Luke'S Hospital - Upper Bucks Campus Hospital, Quakertown, PA, CCN 390035
  • St Luke'S Hospital - Grand View Campus Hospital, Sellersville, PA, CCN 390057

Merit-based Incentive Payment System (MIPS)

Final score
97.13 of 100Reported as apm
Quality
82.27
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN673311PAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St. Luke'S Physician Group, Inc. CurrentSince Nov 25, 2021 Accepting new patients
St Luke'S Physician Group Inc CurrentSince Nov 25, 2021 Accepting new patients
Star Community Health, Inc CurrentSince Jan 3, 2023 Accepting new patients
Star Community Health, Inc CurrentSince Jan 3, 2023 Accepting new patients
St. Luke'S Physician Group, Inc. Current Accepting new patients
St. Luke'S Physician Group, Inc Past Accepting new patients

Locations

511 E 3rd St
Ste 301
Bethlehem, PA 18015
Phone (484) 526-2460

5445 Lanark Rd
Fl 3
Center Valley, PA 18034

5445 Lanark Rd
#3
Center Valley, PA 18034

801 Ostrum St
Fountain Hill, PA 18015
Phone (610) 954-2200

Interoperability endpoints

  • Direct secure messaging: nicholle.daley@slpg.direct-sluhn.org

Organizations & group practices 6

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1626134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639353600000",
    "number": "1164094967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5445 LANARK RD FL 3",
            "city": "CENTER VALLEY",
            "state": "PA",
            "postal_code": "180348694",
            "telephone_number": "484-526-7300",
            "fax_number": "866-449-5832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5445 LANARK RD FL 3",
            "city": "CENTER VALLEY",
            "state": "PA",
            "postal_code": "180348694",
            "telephone_number": "484-526-7300",
            "fax_number": "866-449-5832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "NICHOLLE",
        "middle_name": "ELIZABETH",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-13",
        "last_updated": "2021-12-13",
        "certification_date": "2021-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "RN673311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICHOLLE",
            "last_name": "DALEY",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Center Valley, PA

Sources for this page

Verify at the official NPI Registry.