Individual provider Active NPI

Shannon Leigh Taut, M.D.

  • Pediatrics Physician
  • Northville, MI
National Provider Identifier
1265845770
Registry record updated Feb 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
4301104680 Issued in MI
Practice address
39901 Traditions Dr
Suite 240
Northville, MI 48168-9493
Phone
(248) 305-4400
NPI assigned
Jun 3, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 67156-20 WI
Pediatrics Physician 208000000X 4301104680 MI Primary

Addresses

Primary practice location

39901 Traditions Dr
Suite 240
Northville, MI 48168-9493

Mailing address

3621 S State St
Ann Arbor, MI 48108-1633
Phone (734) 647-5299

Other identifiers 1

IdentifierTypeStateIssuer
1265845770MedicaidWI

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20180725000385 MI Practitioner - Internal Medicine 8325354616 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Toledo Medical College, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1500 E Medical Ctr
Suite 0331
Ann Arbor, MI 48109-0999
Phone (734) 936-5738

1500 E Medical Ctr 2ND Floor Rec
Taubman Center
Ann Arbor, MI 48109-0999
Phone (734) 936-5020

1500 E Medical Ctr Dr
Ann Arbor, MI 48109-0999

1500 E Medical Ctr Dr 1St Flo
Ann Arbor, MI 48109-0999

1500 E Medical Ctr Dr 1St Floor
Ann Arbor, MI 48109-0999

1500 E Medical Ctr Dr 2ND LR
Med Inn
Ann Arbor, MI 48109-0999
Phone (734) 763-5459

1500 E Medical Ctr Dr B2 Floor R
Cancer and Geriatrics Center
Ann Arbor, MI 48109-0999
Phone (734) 936-6274

1500 E Medical Ctr Dr Level B
Cancer and Geriatrics Center
Ann Arbor, MI 48109-0999
Phone (734) 647-8901

39901 Traditions Dr
Northville, MI 48168-9493
Phone (888) 287-1082

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
67156-20WIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of Michigan CurrentSince Jul 10, 2018 Accepting new patients
Regents of the University of Michigan Pediatrics CurrentSince Jul 10, 2018 Accepting new patients
Regents of the University of Michigan Pediatrics Current Accepting new patients
Regents of the University of Michigan Past Accepting new patients

Locations

3621 S State St
Ann Arbor, MI 48108
Phone (734) 647-5229

39901 Traditions Dr
Ste 240
Northville, MI 48168
Phone (248) 305-4400

Interoperability endpoints

  • Direct secure messaging: swagner402397@direct.med.umich.edu

Organizations & group practices 4

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": "1401753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581465600000",
    "number": "1265845770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481081633",
            "telephone_number": "734-647-5299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39901 TRADITIONS DR",
            "address_2": "SUITE 240",
            "city": "NORTHVILLE",
            "state": "MI",
            "postal_code": "481689493",
            "telephone_number": "248-305-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAUT",
        "first_name": "SHANNON",
        "middle_name": "LEIGH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-03",
        "last_updated": "2020-02-12",
        "certification_date": "2020-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "67156-20",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301104680",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265845770",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Northville, MI

Sources for this page

Verify at the official NPI Registry.