Active NPI
Shannon Joe Vaughn, M.D.
- Family Medicine Physician
- Rome, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 046000
- Practice address
- 28 John Davenport Dr NW
Rome, GA 30165-2536 - Phone
- (706) 235-8485
- Fax
- (706) 295-5742
- NPI assigned
- Jul 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 046000 | GA | Primary |
Addresses
Primary practice location
28 John Davenport Dr NW
Rome, GA 30165-2536
Mailing address
420 E 2ND Ave Ste 103
Rome, GA 30161-3210
Phone (706) 509-3000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00798509A | Medicaid | GA |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | svaughn@fmc.gwaydirect.com | ||
| Direct Messaging Address | svaughn914728@CarolinasHealthcareSystem.direct-ci.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050426000092 | GA | Practitioner - Family Practice | 5294774741 | Reassigns benefits to 3 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1025 N Main St
Cedartown, GA 30125-2036
Phone (770) 748-5212
2600 Compass Rd
Glenview, IL 60026-8001
28 John Davenport Dr NW
Rome, GA 30165-2536
Phone (706) 232-1503
5470 Martha Berry Hwy NE
Armuchee, GA 30105-2302
Phone (762) 235-3830
Hospital & facility affiliations
- Coosa Valley Home Health, an Amedisys
- Adoration Home Health
- Pruitthealth at Home - Rome
- Atrium Health Floyd Medical Center
- Atrium Health Floyd Polk Medical Center
- Adventhealth Redmond
- Floyd Cherokee Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 98.9 of 100
- Promoting interoperability
- 97
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046000 | GA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Harbin Clinic, LLC | Family Medicine | Current | Accepting new patients |
| Floyd Healthcare Management Inc | Current | Accepting new patients | |
| Harbin Clinic, LLC | Current | Accepting new patients | |
| 24 On Physicians, P.C. | Current | Accepting new patients | |
| 24 On Physicians, PC | Current | Accepting new patients | |
| Floyd Healthcare Management Inc | Family Medicine | Current | Accepting new patients |
Locations
13000 Deerfield Pkwy
Ste 100
Alpharetta, GA 30004
5470 Martha Berry Hwy NE
Armuchee, GA 30105
Phone (706) 235-1156
1025 N Main St
Cedartown, GA 30125
Phone (770) 748-5212
1412 Milstead Ave NE
Conyers, GA 30012
Phone (770) 918-3000
304 Turner McCall Blvd SW
Rome, GA 30165
Phone (706) 506-5000
28 John Davenport Dr NW
Rome, GA 30165
Phone (706) 232-1503
1825 Martha Berry Blvd NW
Rome, GA 30165
Phone (706) 238-8073
330 Turner McCall Blvd SW
Ste 107
Rome, GA 30165
Phone (706) 509-6439
420 E 2nd Ave
Ste 103
Rome, GA 30161
Phone (706) 509-3278
Interoperability endpoints
- svaughn914728@carolinashealthcaresystem.direct-ci.com
Ownership & related parties
All facility ownership & control disclosures 1
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| Atrium Health Floyd Medical Center | Hospital | Corporate Director | Jan 1, 2020 |
Owned or controlled facilities with NPI records 1
Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.
-
- Rehabilitation Hospital Unit
- Rome, GA
- NPI 1801990213
Corporate Director
Organizations & group practices 7
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.
-
- Family Medicine Physician
- Rome, GA
- NPI 1689610149
Family Medicine, GA
-
- Rehabilitation Clinic/Center
- Glenview, IL
- NPI 1346368248
-
- Specialty Pharmacy
- Rome, GA
- NPI 1548056468
-
- Ambulatory Surgical Clinic/Center
- Cartersville, GA
- NPI 1467016055
-
- Hospitalist Physician
- Attleboro, MA
- NPI 1790104511
Hospital & facility affiliations 8
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Rome, GA
- NPI 1285682955
-
- Home Health Agency
- Cedartown, GA
- NPI 1417016452
-
- Home Health Agency
- Rome, GA
- NPI 1215976626
-
- Home Health Agency
- Ft. Oglethorpe, GA
- NPI 1396996021
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678406400000",
"number": "1164448809",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 E 2ND AVE STE 103",
"city": "ROME",
"state": "GA",
"postal_code": "301613210",
"telephone_number": "706-509-3000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28 JOHN DAVENPORT DR NW",
"city": "ROME",
"state": "GA",
"postal_code": "301652536",
"telephone_number": "706-235-8485",
"fax_number": "706-295-5742"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAUGHN",
"first_name": "SHANNON",
"middle_name": "JOE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-14",
"last_updated": "2023-03-10",
"certification_date": "2023-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "GA",
"license": "046000",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00798509A",
"state": "GA"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "svaughn@fmc.gwaydirect.com",
"affiliation": "N",
"address_1": "28 John Davenport Dr NW",
"city": "Rome",
"state": "GA",
"country_code": "US",
"postal_code": "301652536",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "svaughn914728@CarolinasHealthcareSystem.direct-ci.com",
"affiliation": "N",
"address_1": "28 John Davenport Dr NW",
"city": "Rome",
"state": "GA",
"country_code": "US",
"postal_code": "301652536",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Rome, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.