Shannon Liedquist Tieman, CRNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R214716 Issued in MD

Practice address

7310 Ritchie Hwy Ste 516
Glen Burnie, MD 21061-3099

Phone

(844) 387-7469

NPI assigned

Dec 30, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

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

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Brightwell Health LLCGroup PAC ID 8224437397, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: brightwellhealth.shannontieman@150032.advancedmd-direct.com
• FHIR API: https://api.platform.athenahealth.com/22084/brand/1/csg/1/fhir/r4

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.

• Brightwell Health LLC

  • Internal Medicine Physician
  • Glen Burnie, MD
  • NPI 1215515408

  Nurse Practitioner

  Medicare reassignment Care Compare group NPD
• Maryland Spine and Brain Specialists, LLC

  • Specialist
  • Elkridge, MD
  • NPI 1639359508
  Medicare reassignment NPD
• University of Maryland Community Medical Group, Inc.

  • Family Medicine Physician
  • Baltimore, MD
  • NPI 1477530624
  Medicare reassignment NPD
• University of Maryland Community Medical Group, Inc.

  • Psychiatry Physician
  • La Plata, MD
  • NPI 1679393854
  NPD

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

{
    "created_epoch": "1419897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686009600000",
    "number": "1326436254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7310 RITCHIE HWY STE 516",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210613099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7310 RITCHIE HWY STE 516",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210613099",
            "telephone_number": "844-387-7469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIEMAN",
        "first_name": "SHANNON",
        "middle_name": "LIEDQUIST",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-12-30",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R214716",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MD",
            "license": "R214716",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Lynn Throndset, MSN, FNP-C
• Through the Embers
• John Robert Ticehurst, M.D.
• Donna Lorraine Ticknor, M.D.
• Tidewater LLC
• Kaitlin Tierney, PT, DPT
• Idaat Bisola Timbo-Jalloh
• Time Organization
• Time Organization, Inc
• Eileen Bradley Timm, R.N.

• Psychiatric/Mental Health Nurse Practitioner in Glen Burnie, MD
• Providers in Glen Burnie, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.