Shannon N Radomski, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

D91293 Issued in MD

Practice address

5401 Old Court Rd
Randallstown, MD 21133-5103

Phone

(410) 521-2200

Fax

(410) 521-7669

NPI assigned

Mar 19, 2019

Sex

Female

Sole proprietor

No

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Northwest Hospital Center, Inc

  • Hospitalist Physician
  • Randallstown, MD
  • NPI 1508961988

  Surgery

  Medicare reassignment NPD
• Northwest Hospital Center, Inc.

  • Acute Care Nurse Practitioner
  • Randallstown, MD
  • NPI 1235669599
  NPD

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

{
    "created_epoch": "1552953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626134400000",
    "number": "1376002154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5401 OLD COURT RD",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211335103",
            "telephone_number": "410-521-2200",
            "fax_number": "410-521-7669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5401 OLD COURT RD",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211335103",
            "telephone_number": "410-521-2200",
            "fax_number": "410-521-7669"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "The Johns Hopkins Hospital",
            "address_2": "1800 Orleans Street-Tower 110",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212870010",
            "country_code": "US",
            "telephone_number": "410-955-5020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RADOMSKI",
        "first_name": "SHANNON",
        "middle_name": "N",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-19",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MD",
            "license": "D91293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia Purchla
• Purebalance Health & Wellness LLC
• Tahna Purnell, LCPC
• Lisa M Quarles, PA
• Michelle Palmer Queen, LCSW-C
• Iyabo Aminat Rafiu
• Haramrit Rajan, PA-C
• Randall Emergency Physicians LLC
• Andrea Nicole Randall, LCSW-C
• Randallstown Center, LLC

• Surgery Physician in Randallstown, MD
• Providers in Randallstown, MD by specialty
• Surgery Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2021; 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.

Verify at the official NPI Registry.