Shannon Wagner

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

2 Pine Tree Dr
Arden Hills, MN 55112-3754

Phone

(651) 635-8000

NPI assigned

May 6, 2024

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

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Clinic PAGroup PAC ID 2769384205, 50 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• North Clinic, PA

  • Family Medicine Physician
  • Brooklyn Park, MN
  • NPI 1114962206
  Medicare reassignment Care Compare group NPD
• North Clinic, PA

  • Multi-Specialty Clinic/Center
  • Brooklyn Park, MN
  • NPI 1407011760
  NPD
• West Imaging, LLC

  • Diagnostic Radiology Physician
  • Robbinsdale, MN
  • NPI 1053311399
  NPD (past)

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

{
    "created_epoch": "1714953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714953600000",
    "number": "1255188389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 ABBOTT AVE N",
            "city": "ROBBINSDALE",
            "state": "MN",
            "postal_code": "554221416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 PINE TREE DR",
            "city": "ARDEN HILLS",
            "state": "MN",
            "postal_code": "551123754",
            "telephone_number": "651-635-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "SHANNON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-06",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maricela Esperanza Varela
• Cynthia L Vehe, MD
• Alexis Mackenzie Venaro
• Grace Kennidy Virtue
• Aviya Joy Wadsager
• Walgreen Co
• Gabriella Marie Wall
• Cierra Wandro
• Hope Nevaeh Wells
• Joseph Francis Wells

• Physician Assistant in Arden Hills, MN
• Providers in Arden Hills, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; 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.