Individual provider Active NPI

Shannon Nicole Davidson, CRNA

  • Certified Registered Nurse Anesthetist
  • Topeka, KS
National Provider Identifier
1174875827
Registry record updated Apr 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4416 Issued in CA
Practice address
1500 SW 10TH Ave
Topeka, KS 66604-1301
Phone
(785) 235-3451
NPI assigned
Oct 4, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 99055 KS
Certified Registered Nurse Anesthetist 367500000X 4416 CA Primary

Addresses

Primary practice location

1500 SW 10TH Ave
Topeka, KS 66604-1301

Mailing address

823 SW Mulvane St
Topeka, KS 66606-1764
Phone (785) 235-3451

Other names 1

  • Shannon Bennett Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140122001417 CA Practitioner - Certified Registered Nurse Anesthetist (Crna) 0446405484 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Redding Anesthesia Associates LPGroup PAC ID 4789982786, 5 clinicians

Practice addresses (Care Compare)

1825 Sonoma St
Redding, CA 96001-2519
Phone (530) 246-7000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
4416CAMDAddiction (Substance Use Disorder) Counselor
99055KSMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - Anesthesia PC CurrentSince May 1, 2022 Accepting new patients
Mayers Memorial Hospital District CurrentSince Apr 5, 2023 Accepting new patients
Cep America - Anesthesia, PC Current Accepting new patients
Redding Anesthesia Associates LP Nurse Anesthetist, Certified Registered CurrentSince May 1, 2019 Accepting new patients
Cep America - Anesthesia PC CurrentSince May 1, 2022 Accepting new patients
Last Frontier Healthcare District Past Accepting new patients
Last Frontier Healthcare District Past Accepting new patients
Dignity Health Past Accepting new patients
Cep America - Anesthesia PC Past Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

43563 State Highway 299 E
Fl River Mls, CA 96028
Phone (530) 336-5511

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

400 Forest Ave
Palo Alto, CA 94301
Phone (650) 289-1208

2175 Rosaline Ave
Redding, CA 96001
Phone (530) 225-7247

2900 Eureka Way
Redding, CA 96001
Phone (530) 225-8700

2179 Court St
Redding, CA 96001
Phone (530) 246-7000

1825 Sonoma St
Redding, CA 96001
Phone (530) 243-8667

2175 Rosaline Ave
Ste A
Redding, CA 96001
Phone (530) 225-7400

Organizations & group practices 11

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": "1349308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650412800000",
    "number": "1174875827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 SW MULVANE ST",
            "city": "TOPEKA",
            "state": "KS",
            "postal_code": "666061764",
            "telephone_number": "785-235-3451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 SW 10TH AVE",
            "city": "TOPEKA",
            "state": "KS",
            "postal_code": "666041301",
            "telephone_number": "785-235-3451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "SHANNON",
        "middle_name": "NICOLE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-04",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KS",
            "license": "99055",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CA",
            "license": "4416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "BENNETT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Topeka, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.