Active NPI
Shannan M Dennis, PAC
- Physician Assistant
- Lima, OH
National Provider Identifier
1295774883
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 50001800
- Practice address
- 730 W Market St
Lima, OH 45801-4602 - Phone
- (419) 227-3361
- Fax
- (419) 226-9826
- NPI assigned
- Jun 6, 2006
- Last updated
- May 16, 2008
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 50001800 | OH | Primary |
Addresses
Primary practice location
730 W Market St
Lima, OH 45801-4602
Mailing address
4750 Hempstead Station Dr
Kettering, OH 45429-5164
Phone (800) 875-0136
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00396192 | Other | OH | MEDICARE RR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050616000765 | OH | Practitioner - Physician Assistant | 4688618903 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50001800 | OH | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Van Wert Medical Services, LTD. | Current | Accepting new patients | |
| Lima Memorial Joint Operating Company | Past | Accepting new patients | |
| Observation Physicians of Northwest Ohio LLC | Past | Accepting new patients |
Locations
1250 S Washington St
Van Wert, OH 45891
Phone (419) 232-2077
Interoperability endpoints
- shannan.dennis.1@14940.direct.athenahealth.com
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.
-
dba Lima Memorial Health System
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
-
- Emergency Medicine Physician
- Toledo, OH
- NPI 1700462967
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210896000000",
"number": "1295774883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4750 HEMPSTEAD STATION DR",
"city": "KETTERING",
"state": "OH",
"postal_code": "454295164",
"telephone_number": "800-875-0136",
"fax_number": "937-619-4231"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "730 W MARKET ST",
"city": "LIMA",
"state": "OH",
"postal_code": "458014602",
"telephone_number": "419-227-3361",
"fax_number": "419-226-9826"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DENNIS",
"first_name": "SHANNAN",
"middle_name": "M",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-06",
"last_updated": "2008-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OH",
"license": "50001800",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RR",
"identifier": "P00396192",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Lima, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2008; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.