Active NPI
Davis Shannon, MSW
- Student in an Organized Health Care Education/Training Program
- Bloomington, IL
National Provider Identifier
1265985170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 702 W Chestnut St
Bloomington, IL 61701-2814 - Phone
- (217) 649-5765
- NPI assigned
- Jul 27, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | IL | Primary |
Addresses
Primary practice location
702 W Chestnut St
Bloomington, IL 61701-2814
Mailing address
702 W Chestnut St
Bloomington, IL 61701-2814
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1469577600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1776384000000",
"number": "1265985170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "702 W CHESTNUT ST",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617012814"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "702 W CHESTNUT ST",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617012814",
"telephone_number": "217-649-5765"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANNON",
"first_name": "DAVIS",
"credential": "MSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-07-27",
"last_updated": "2026-04-17",
"certification_date": "2026-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.