Individual provider Active NPI

Robert Shannon, FNP

  • Family Nurse Practitioner
  • Wasco, CA
National Provider Identifier
1164879839
Registry record updated Apr 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95035529 Issued in CA
Practice address
2101 7TH St
Wasco, CA 93280-1502
Phone
(661) 758-2263
NPI assigned
May 23, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 8, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95035529 CA Primary

Addresses

Primary practice location

2101 7TH St
Wasco, CA 93280-1502

Mailing address

4900 Califonia Ave
Suite 400-B
Bakersfield, CA 93309
Phone (661) 459-1900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20160810002426 CA Practitioner - Nurse Practitioner 8426342692 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Omni Family HealthGroup PAC ID 9234176363, 93 clinicians

Practice addresses (Care Compare)

2101 7TH St
Suite a F
Wasco, CA 93280-1502
Phone (866) 707-6664

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Omni Family Health Current Accepting new patients
Omni Family Health CurrentSince Jul 1, 2016 Accepting new patients
Omni Family Health CurrentSince Jul 1, 2016 Accepting new patients
Bakersfield Memorial Hospital Past Accepting new patients
Omni Family Health Past Accepting new patients
Hanford Community Hospital Past Accepting new patients

Locations

210 N Chester Ave
Bakersfield, CA 93308
Phone (661) 325-6800

4900 California Ave
Ste 400B
Bakersfield, CA 93309
Phone (661) 630-7046

277 E Front St
Buttonwillow, CA 93206
Phone (661) 630-7381

912 Fremont St
Delano, CA 93215
Phone (661) 459-1974

2101 7th St
Bldg Af
Wasco, CA 93280

2101 7th St
Wasco, CA 93280
Phone (661) 630-7046

2101 7th St
Ste Af
Wasco, CA 93280

Interoperability endpoints

  • Direct secure messaging: robert.shannon.p1@direct.omnifamilyhealth.nextgenshare.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1463961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649376000000",
    "number": "1164879839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4900 CALIFONIA AVE",
            "address_2": "SUITE 400-B",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "93309",
            "telephone_number": "661-459-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 7TH ST",
            "city": "WASCO",
            "state": "CA",
            "postal_code": "932801502",
            "telephone_number": "661-758-2263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "ROBERT",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-05-23",
        "last_updated": "2022-04-08",
        "certification_date": "2022-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95035529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wasco, CA

Sources for this page

Verify at the official NPI Registry.