Individual provider Active NPI

Shannon Michelle Connole, D.O.

  • Obstetrics & Gynecology Physician
  • Maumee, OH
National Provider Identifier
1295051662
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
34011453 Issued in OH
Practice address
660 Beaver Creek Cir
Suite 200
Maumee, OH 43537-1745
Phone
(419) 891-6201
Fax
(419) 893-1227
NPI assigned
Apr 10, 2010
Last updated
Nov 3, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 34011453 OH Primary

Addresses

Primary practice location

660 Beaver Creek Cir
Suite 200
Maumee, OH 43537-1745

Mailing address

5855 Monroe St
Sylvania, OH 43560-2269
Phone (419) 824-7469

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sconnole13195@epicdirect.promedica.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20140827002955 OH Practitioner - Obstetrics/Gynecology 5496973752 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Promedica Central PhysiciansGroup PAC ID 2365348190, 785 clinicians

Practice addresses (Care Compare)

2109 Hughes Dr
Suite 450
Toledo, OH 43606-5102
Phone (419) 291-2003

2142 N Cove Blvd
Toledo, OH 43606-3895
Phone (419) 291-4000

2901 N Reynolds Rd
Toledo, OH 43606
Phone (419) 578-7700

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34011453OHMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Central Physicians Obstetrics & Gynecology CurrentSince Jul 5, 2014 Accepting new patients
Promedica Central Physicians CurrentSince Jul 5, 2014 Accepting new patients
The Toledo Hospital Past Accepting new patients

Locations

660 Beaver Creek Cir
Ste 200
Maumee, OH 43537
Phone (419) 891-6201

5700 Monroe St
Sylvania, OH 43560
Phone (419) 473-6622

5855 Monroe St
Sylvania, OH 43560
Phone (419) 824-7264

100 Madison Ave
Toledo, OH 43604
Phone (567) 585-1964

2109 Hughes Dr
Ste 450
Toledo, OH 43606
Phone (419) 251-3112

Interoperability endpoints

  • Direct secure messaging: sconnole13195@direct.promedica.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1270857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1295051662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5855 MONROE ST",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435602269",
            "telephone_number": "419-824-7469",
            "fax_number": "419-824-7359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 BEAVER CREEK CIR",
            "address_2": "SUITE 200",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435371745",
            "telephone_number": "419-891-6201",
            "fax_number": "419-893-1227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOLE",
        "first_name": "SHANNON",
        "middle_name": "MICHELLE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-10",
        "last_updated": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OH",
            "license": "34011453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sconnole13195@epicdirect.promedica.org",
            "affiliation": "N",
            "address_1": "100 Madison Ave",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436041516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Maumee, OH

Sources for this page

Verify at the official NPI Registry.