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Individual provider Active NPI

Cheryl Lynn Shannon, NURSE PRACTITIONER

  • Nurse Practitioner
  • Corvallis, OR
National Provider Identifier
1164159091
Registry record updated Dec 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
202211114NP-PP Issued in OR
Practice address
3615 NW Samaritan Dr Ste 201
Corvallis, OR 97330-3771
Phone
(541) 768-5930
NPI assigned
Aug 2, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2022

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 202211114NP-PP OR Primary

Addresses

Primary practice location

3615 NW Samaritan Dr Ste 201
Corvallis, OR 97330-3771

Mailing address

PO Box 1189
Corvallis, OR 97339-1189

Other practice location 1

1515 Village Dr
Cottage Grove, OR 97424-9700
Phone (541) 767-5220

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cshannon3566@samhealth.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20221129001159 OR Practitioner - Nurse Practitioner 8022486893 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of South Alabama College of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1460 G St
Springfield, OR 97477-4112
Phone (541) 726-4400

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.14 of 100Reported as group
Quality
85.78
Promoting interoperability
100
Improvement activities
40
Cost
78.31

Merit-based Incentive Payment System (MIPS)

Final score
93.65 of 100Reported as group
Quality
86.8
Promoting interoperability
100
Improvement activities
40
Cost
86.36

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
92.23
Promoting interoperability
100
Improvement activities
40
Cost
100

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
202211114NP-PPORMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
South Sound Inpatient Physicians PLLC CurrentSince Feb 13, 2025 Accepting new patients

Locations

1460 G St
Springfield, OR 97477
Phone (541) 431-0665

Interoperability endpoints

  • Direct secure messaging: cshannon@yourcarecommunity.org
  • Direct secure messaging: cshannon3566@samhealth.direct-ci.com

Organizations & group practices 1

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 30

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

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1659398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671667200000",
    "number": "1164159091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1189",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973391189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3615 NW SAMARITAN DR STE 201",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303771",
            "telephone_number": "541-768-5930"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1515 Village Dr",
            "address_purpose": "LOCATION",
            "city": "Cottage Grove",
            "state": "OR",
            "postal_code": "974249700",
            "country_code": "US",
            "telephone_number": "541-767-5220",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "CHERYL",
        "middle_name": "LYNN",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-02",
        "last_updated": "2022-12-22",
        "certification_date": "2022-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OR",
            "license": "202211114NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cshannon3566@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "3615 NW Samaritan Dr Ste 201",
            "city": "Corvallis",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973303771",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Corvallis, OR

Sources for this page

Verify at the official NPI Registry.