Individual provider Active NPI

Shannon Yarima, MD

  • Medical Physician Assistant
  • Forest Hills, NY
National Provider Identifier
1275612467
Registry record updated Jan 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
177981 Issued in NY
Practice address
10201 66TH Rd
Forest Hills, NY 11375-2029
Phone
(718) 830-4212
NPI assigned
Nov 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 177981 NY Primary

Addresses

Primary practice location

10201 66TH Rd
Forest Hills, NY 11375-2029

Mailing address

10201 66TH Rd
Forest Hills, NY 11375-2029
Phone (718) 830-4212

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20100927000923 TX Practitioner - Physician Assistant 0143203349 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Houston Carenow Urgent Care PLLCGroup PAC ID 7012291958, 113 clinicians

Practice addresses (Care Compare)

102 W 11TH St
Houston, TX 77008-6857
Phone (835) 539-4707

10422 Research Forest Dr
Magnolia, TX 77354-6155
Phone (832) 702-7699

1150 W Dallas St
Conroe, TX 77301-2208
Phone (713) 955-4510

300 Northpark Dr
Kingwood, TX 77339-1672
Phone (281) 310-8445

9055 Spencer Hwy
La Porte, TX 77571-3870
Phone (346) 954-6270

9110 Barker Cypress Rd
Cypress, TX 77433-3047
Phone (281) 746-4944

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
177981NYMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
No. Shore Emergency Med at Forest Hill Past Accepting new patients

Organizations & group practices 3

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": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263254400000",
    "number": "1275612467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10201 66TH RD",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113752029",
            "telephone_number": "718-830-4212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10201 66TH RD",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113752029",
            "telephone_number": "718-830-4212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YARIMA",
        "first_name": "SHANNON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-06",
        "last_updated": "2010-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "177981",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Hills, NY

Sources for this page

Verify at the official NPI Registry.