Individual provider Active NPI

Shannon Penick Pryor, MD

  • Otolaryngology Physician
  • Kensington, MD
National Provider Identifier
1164598348
Registry record updated Nov 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
D0053881 Issued in MD
Practice address
10810 Connecticut Avenue
Kensington, MD 20895-2138
Phone
(301) 929-7100
Fax
(301) 929-7114
NPI assigned
Nov 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2011

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngic Allergy Physician 207YX0602X MD33647 DC
Otolaryngic Allergy Physician 207YX0602X 38383 CO
Otolaryngology Physician 207Y00000X D0053881 MD Primary
Otolaryngology Physician 207Y00000X 0101241142 VA

Addresses

Primary practice location

10810 Connecticut Avenue
Kensington, MD 20895-2138

Mailing address

2101 E Jefferson St
Kaiser Permanente Medicare Enrollment Unit
Rockville, MD 20852-4908
Phone (301) 816-6660

Other names 1

  • Shannon Penick Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100126000406 DC Practitioner - Otolaryngology 6002958238 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Tulane University School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medstar Medical Group II LLCGroup PAC ID 0547413825, 3,726 clinicians

Practice addresses (Care Compare)

3800 Reservoir Rd NW
Washington, DC 20007-2113
Phone (202) 444-2000

Hospital & facility affiliations

  • Medstar Georgetown University Hospital Hospital, Washington, DC, CCN 090004

Merit-based Incentive Payment System (MIPS)

Final score
82.97 of 100Reported as group
Quality
72.87
Promoting interoperability
100
Improvement activities
40
Cost
67.82

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D0053881MDMDOtolaryngology Physician
0101241142VAMDOtolaryngology Physician
38383COMDOtolaryngic Allergy Physician
MD33647DCMDOtolaryngic Allergy Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medstar Medical Group II LLC CurrentSince Apr 19, 2014 Accepting new patients
Medstar Medical Group II LLC CurrentSince Apr 19, 2014 Accepting new patients
Medstar Medical Group II LLC CurrentSince May 1, 2025 Accepting new patients
MGMC, LLC Current Accepting new patients
Medstar Medical Group II LLC Past Accepting new patients

Locations

1145 19th St NW
Ste 311
Washington, DC 20036
Phone (202) 429-2401

3800 Reservoir Rd NW
Washington, DC 20007
Phone (202) 687-2203

1133 21st St NW
Fl 5
Washington, DC 20036
Phone (202) 416-2000

3800 Reservoir Rd NW
Bldg 1
Washington, DC 20007
Phone (202) 444-0924

6862 Elm St
Ste 800B
Mc Lean, VA 22101
Phone (202) 944-5301

Organizations & group practices 5

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 1

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": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321401600000",
    "number": "1164598348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 E JEFFERSON ST",
            "address_2": "KAISER PERMANENTE MEDICARE ENROLLMENT UNIT",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208524908",
            "telephone_number": "301-816-6660",
            "fax_number": "301-816-6308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10810 CONNECTICUT AVENUE",
            "city": "KENSINGTON",
            "state": "MD",
            "postal_code": "208952138",
            "telephone_number": "301-929-7100",
            "fax_number": "301-929-7114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRYOR",
        "first_name": "SHANNON",
        "middle_name": "PENICK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-28",
        "last_updated": "2011-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0602X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngic Allergy",
            "state": "DC",
            "license": "MD33647",
            "primary": false
        },
        {
            "code": "207YX0602X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngic Allergy",
            "state": "CO",
            "license": "38383",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MD",
            "license": "D0053881",
            "primary": true
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "VA",
            "license": "0101241142",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "PENICK",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Kensington, MD

Sources for this page

Verify at the official NPI Registry.