Individual provider Active NPI

Shannon Nicole Hogan

  • Family Nurse Practitioner
  • Elizabeth City, NC
National Provider Identifier
1356826705
Registry record updated Oct 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5011082 Issued in NC
Practice address
1144 N Road St
Elizabeth City, NC 27909-3473
Phone
(252) 335-0531
NPI assigned
Oct 2, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Registered Nurse 163WC0200X 0001270844 VA
Family Nurse Practitioner 363LF0000X 5011082 NC Primary

Addresses

Primary practice location

1144 N Road St
Elizabeth City, NC 27909-3473

Mailing address

5112 Clear Lake Cir
Virginia Beach, VA 23464-6028
Phone (443) 807-6012

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, MD, DC, CT4 enrollments
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 4

Enrollment IDStateProvider typePAC IDDetails
I20181210003407 NC Practitioner - Nurse Practitioner 0042554594 Reassigns benefits to 1 organization
I20210112000340 MD Practitioner - Nurse Practitioner 0042554594 Reassigns benefits to 1 organization
I20210112000417 DC Practitioner - Nurse Practitioner 0042554594 Reassigns benefits to 1 organization
I20260623003141 CT Practitioner - Nurse Practitioner 0042554594 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1 California St
Suite 2300
San Francisco, CA 94111-3720

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5011082NCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Medstar Urgent Care LLC CurrentSince Jan 1, 2021 Accepting new patients
Medstar Urgent Care, LLC Current Accepting new patients
Medstar Urgent Care LLC CurrentSince Jan 1, 2021 Accepting new patients
Medstar Urgent Care LLC CurrentSince Jan 1, 2021 Accepting new patients
Waterway Emergency Physicians LLC Past Accepting new patients

Locations

6317 York Rd
Baltimore, MD 21212
Phone (443) 777-6890

12 Medstar Blvd
Bel Air, MD 21015
Phone (410) 877-8087

3064 Waldorf Market Pl
Waldorf, MD 20603
Phone (301) 932-5960

11915 Georgia Ave
Wheaton, MD 20902
Phone (301) 942-4505

Interoperability endpoints

  • Direct secure messaging: shannon.hogan.1@30520.direct.athenahealth.com

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1538438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538784000000",
    "number": "1356826705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5112 CLEAR LAKE CIR",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234646028",
            "telephone_number": "443-807-6012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1144 N ROAD ST",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279093473",
            "telephone_number": "252-335-0531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOGAN",
        "first_name": "SHANNON",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-02",
        "last_updated": "2018-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "VA",
            "license": "0001270844",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5011082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabeth City, NC

Sources for this page

Verify at the official NPI Registry.