NPIMap

Individual provider Active NPI

Shanna Brynne Williams, D.O.

  • Surgery Physician
  • Wyoming, MI
National Provider Identifier
1245416775
Registry record updated Jan 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
5101017235 Issued in MI
Practice address
1045 Gezon Pkwy SW
Wyoming, MI 49509-9542
Phone
(616) 456-5311
Fax
(616) 456-7955
NPI assigned
Jan 15, 2008
Last updated
Jan 15, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 5101017235 MI Primary

Addresses

Primary practice location

1045 Gezon Pkwy SW
Wyoming, MI 49509-9542

Mailing address

1045 Gezon Pkwy SW
Wyoming, MI 49509-9542
Phone (616) 456-5311

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121011000200 MI Practitioner - General Surgery 1759530504 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West Michigan Surgical Specialists PLCGroup PAC ID 3870583727, 11 clinicians
Metropolitan HospitalGroup PAC ID 5597651836, 421 clinicians

Practice addresses (Care Compare)

10047 Crossroad CT SE
Caledonia, MI 49316-7316
Phone (616) 685-8850

1045 Gezon Pkwy SW
Wyoming, MI 49509-9542
Phone (616) 456-5311

2122 Health Dr SW
Wyoming, MI 49519-9698

5900 Byron Ctr Ave
Wyoming, MI 49519-9606

5900 Byron Ctr Ave SW
Wyoming, MI 49519-9606
Phone (616) 252-3243

5900 Byron Ctr Swave
Wyoming, MI 49519-9606
Phone (616) 252-7200

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Mastectomy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue18
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101017235MIMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health Saint Mary's Medical Group CurrentSince Aug 1, 2013 Accepting new patients
Advantage Health Saint Mary's Medical Group CurrentSince Aug 1, 2013 Accepting new patients
Metropolitan Hospital CurrentSince Feb 18, 2013 Accepting new patients
Advantage Health/Saint Mary's Medical Group Current Accepting new patients
West Michigan Surgical Specialists PLC Surgery CurrentSince Oct 8, 2012 Accepting new patients
Metropolitan Hospital CurrentSince Feb 18, 2013 Accepting new patients
Metropolitan Hospital Past Accepting new patients
Advantage Health Saint Mary's Medical Group Past Accepting new patients

Locations

10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850

245 State St SE
Ste 1A
Grand Rapids, MI 49503

1045 Gezon Pkwy SW
Wyoming, MI 49509
Phone (616) 456-5311

2122 Health Dr SW
Wyoming, MI 49519
Phone (616) 252-5950

5900 Byron Center Ave SW
Wyoming, MI 49519
Phone (616) 252-3243

Interoperability endpoints

  • Direct secure messaging: swilliams2373@direct.metrohealth.net

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1200355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610668800000",
    "number": "1245416775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1045 GEZON PKWY SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495099542",
            "telephone_number": "616-456-5311",
            "fax_number": "616-456-7955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 GEZON PKWY SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495099542",
            "telephone_number": "616-456-5311",
            "fax_number": "616-456-7955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "SHANNA",
        "middle_name": "BRYNNE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-15",
        "last_updated": "2021-01-15",
        "certification_date": "2021-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "5101017235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyoming, MI

Sources for this page

Verify at the official NPI Registry.