NPIMap

Individual provider Active NPI

Shannon Wang Clark, MD

  • Neurological Surgery Physician
  • Norfolk, VA
National Provider Identifier
1316258569
Registry record updated Oct 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
0101261902 Issued in VA
Practice address
301 Riverview Ave Ste 202a
Norfolk, VA 23510-1065
Phone
(757) 252-9140
Fax
(757) 793-4149
NPI assigned
Jun 22, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 5, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X MT197142 PA
Neurological Surgery Physician 207T00000X 0101261902 VA Primary

Addresses

Primary practice location

301 Riverview Ave Ste 202a
Norfolk, VA 23510-1065

Mailing address

301 Riverview Ave Ste 202a
Norfolk, VA 23510-1065
Phone (757) 252-9140

Other practice location 1

1000 Walnut St
1506
Philadelphia, PA 19107-5795
Phone (813) 527-4403

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170804001031 VA Practitioner - Neurosurgery 6507137890 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
University of South Florida College of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sentara Medical GroupGroup PAC ID 8921903923, 1,396 clinicians
Martha Jefferson Medical Group LLCGroup PAC ID 5991889081, 197 clinicians

Practice addresses (Care Compare)

301 Riverview Ave
Suite 202a
Norfolk, VA 23510-1065
Phone (757) 252-9015

500 Martha Jefferson Dr
Charlottesville, VA 22911-4668
Phone (434) 654-8960

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion92
Laminectomy or laminotomy (partial removal of spine bones)31
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MT197142PAMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Martha Jefferson Medical Group LLC Neurological Surgery CurrentSince Sep 1, 2025 Accepting new patients
Sentara Medical Group CurrentSince Aug 7, 2017 Accepting new patients
Martha Jefferson Hospital PastSince Sep 1, 2025 Accepting new patients

Locations

500 Martha Jefferson Dr
#415A
Charlottesville, VA 22911
Phone (434) 654-8960

1646 Park Ridge Dr
Crozet, VA 22932
Phone (434) 654-2760

301 Riverview Ave
Ste 202
Norfolk, VA 23510
Phone (757) 252-9015

301 Riverview Ave
Ste 202A
Norfolk, VA 23510
Phone (757) 252-9015

850 Kempsville Rd
Norfolk, VA 23502
Phone (757) 261-0162

1080 First Colonial Rd
Ste 400
Virginia Beach, VA 23454
Phone (757) 395-1880

Interoperability endpoints

  • Direct secure messaging: sclark315287@direct.sentara.net

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.

Hospital & facility affiliations 8

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": "1277164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633392000000",
    "number": "1316258569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 RIVERVIEW AVE STE 202A",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235101065",
            "telephone_number": "757-252-9140",
            "fax_number": "757-793-4149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 RIVERVIEW AVE STE 202A",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235101065",
            "telephone_number": "757-252-9140",
            "fax_number": "757-793-4149"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Walnut St",
            "address_2": "1506",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191075795",
            "country_code": "US",
            "telephone_number": "813-527-4403",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SHANNON",
        "middle_name": "WANG",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-22",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "PA",
            "license": "MT197142",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "VA",
            "license": "0101261902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norfolk, VA

Sources for this page

Verify at the official NPI Registry.