Individual provider Active NPI

Shanna Danielle Raphael, PA

  • Physician Assistant
  • Baltimore, MD
National Provider Identifier
1336704675
Registry record updated Sep 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
5601 Loch Raven Blvd
Baltimore, MD 21239-2945
Phone
(443) 834-4351
NPI assigned
May 2, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

5601 Loch Raven Blvd
Baltimore, MD 21239-2945

Mailing address

2079 Misty Meadow Rd
Finksburg, MD 21048-1742

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20201026001187 MD Practitioner - Physician Assistant 9335569656 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medstar Medical Group II LLCGroup PAC ID 0547413825, 3,726 clinicians

Practice addresses (Care Compare)

1406 Crain S Hwy 106
Glen Burnie, MD 21061-4086
Phone (410) 768-6440

5601 Lloch Raven Blvd
Baltimore, MD 21239-2945
Phone (410) 581-1200

5601 Loch Raven Blvd Russel
Ste2
Baltimore, MD 21239-2945
Phone (443) 444-5600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.34 of 100Reported as group
Quality
67.9
Promoting interoperability
100
Improvement activities
40
Cost
69.47

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Medstar Medical Group II LLC CurrentSince Nov 1, 2020 Accepting new patients

Locations

5601 Loch Raven Blvd
Baltimore, MD 21239
Phone (443) 444-4714

1406 Crain Hwy S
Ste 106
Glen Burnie, MD 21061
Phone (410) 768-6440

Organizations & group practices 1

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 1

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": "1556755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601251200000",
    "number": "1336704675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2079 MISTY MEADOW RD",
            "city": "FINKSBURG",
            "state": "MD",
            "postal_code": "210481742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5601 LOCH RAVEN BLVD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212392945",
            "telephone_number": "443-834-4351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAPHAEL",
        "first_name": "SHANNA",
        "middle_name": "DANIELLE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-02",
        "last_updated": "2020-09-28",
        "certification_date": "2020-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.