Shannon S. Gulle, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

004842 Issued in GA

Practice address

210 E Derenne Ave
Savannah, GA 31405-6736

Phone

(912) 644-5300

Fax

(912) 644-5260

NPI assigned

Jul 17, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA, SC2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Optim Orthopedics LLCGroup PAC ID 9931427002, 101 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Joseph'S Hospital - Savannah Hospital, Savannah, GA, CCN 110043
• Candler Hospital Hospital, Savannah, GA, CCN 110024

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shannon.gulle.1@16403.direct.athenahealth.com

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.

• Optim Orthopedics, LLC

  • Orthopaedic Surgery Physician
  • Bluffton, SC
  • NPI 1528451481
  Medicare reassignment Care Compare group NPD
• Optim Orthopedics, LLC

  • Orthopaedic Surgery Physician
  • Savannah, GA
  • NPI 1780077982
  Medicare reassignment
• Optim Orthopedics, LLC

  • Orthopaedic Surgery Physician
  • Jesup, GA
  • NPI 1467845404
  NPD
• Optim Orthopedics, LLC

  • Orthopaedic Surgery Physician
  • Brunswick, GA
  • NPI 1487047726
  NPD
• Optim Orthopedics, LLC

  • Orthopaedic Surgery Physician
  • Richmond Hill, GA
  • NPI 1548653330
  NPD (past)
• Optim Orthopedics, LLC

  • Orthopaedic Surgery Physician
  • Midway, GA
  • NPI 1821639758
  NPD (past)
• The Orthopaedic and Sports Medicine Center of Camden, P.C.

  • Orthopaedic Surgery Physician
  • Kingsland, GA
  • NPI 1326006016
  NPD (past)

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

• Candler Hospital Incorporated

  • General Acute Care Hospital
  • Savannah, GA
  • NPI 1275527889
  Care Compare affiliation
• Saint Joseph'S Hospital, Inc.

  • General Acute Care Hospital
  • Savannah, GA
  • NPI 1063406684
  Care Compare affiliation

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374537600000",
    "number": "1265459010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 E DERENNE AVENUE",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "31405",
            "telephone_number": "912-644-5300",
            "fax_number": "912-644-5260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 E DERENNE AVE",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314056736",
            "telephone_number": "912-644-5300",
            "fax_number": "912-644-5260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GULLE",
        "first_name": "SHANNON",
        "middle_name": "S.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2013-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "004842",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA 9104234",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "52207283-001",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "889219382A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Annette Gubert, LCSW
• Melissa Guerra-Wallace, MD
• Phoebe Grace Guidry, MD
• Chantell Mobley Guillory
• Steffani Guillory
• Naomi Gunadeva, MD
• Gunkel Cardiology Group, LLC
• Dieter Karl Gunkel, M.D.
• Brenda Gunter, LPN
• Anjuli Mohan Gupta, D.O

• Physician Assistant in Savannah, GA
• Providers in Savannah, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2013; 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.