Shanna Rachelle Vidor, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

55689 Issued in MN

Practice address

5219 St John Drive
Nett Lake, MN 55772-8232

Phone

(218) 757-3295

NPI assigned

May 3, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Shanna Rachelle Landgren Former name

Medicare fee-for-service enrollment

Enrolled in MN

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

Specialty

Family Practice

Education

University of North Dakota School of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bois Forte Reservation Tribal GovernmentGroup PAC ID 7517879778, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Essentia Health Virginia Hospital, Virginia, MN, CCN 240084
• Essentia Health St Mary'S Medical Center Hospital, Duluth, MN, CCN 240002
• Cook Hospital Hospital, Cook, MN, CCN 241312

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Bois Forte Reservation Tribal Government

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Nett Lake, MN
  • NPI 1073530150

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Bois Forte Reservation Tribal Government

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Nett Lake, MN
  • NPI 1972666469
  NPD

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

• Cook Hospital

  • Critical Access Hospital
  • Cook, MN
  • NPI 1992763858
  Care Compare affiliation
• Essentia Health Virginia, LLC

  • General Acute Care Hospital
  • Virginia, MN
  • NPI 1083617120
  Care Compare affiliation
• St Marys Medical Center

  • General Acute Care Hospital
  • Duluth, MN
  • NPI 1457393035
  Care Compare affiliation
• St. Marys Medical Center

  • Air Ambulance
  • Duluth, MN
  • NPI 1841359478

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1304380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592438400000",
    "number": "1215229729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5219 ST JOHN DRIVE",
            "city": "NETT LAKE",
            "state": "MN",
            "postal_code": "557728232",
            "telephone_number": "218-757-3295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5219 ST JOHN DRIVE",
            "city": "NETT LAKE",
            "state": "MN",
            "postal_code": "557728232",
            "telephone_number": "218-757-3295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIDOR",
        "first_name": "SHANNA",
        "middle_name": "RACHELLE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-03",
        "last_updated": "2020-06-18",
        "certification_date": "2020-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "55689",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215229729",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01105126",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "1215229729",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1215229729",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNA",
            "last_name": "LANDGREN",
            "middle_name": "RACHELLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Melissa Joan Grzybowski
• Lance E Hardwig, P.A,
• Andrew Thomas Jones, DDS
• Julie Skoglund, PHARMD
• St. Louis & Koochiching Cos Ind School Dist 707
• Joe Witt, LP

• Family Medicine Physician in Nett Lake, MN
• Providers in Nett Lake, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; 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.

Verify at the official NPI Registry.