Active NPI
Shannon M Rottman, PA-C
- Physician Assistant
- Marysville, MI
National Provider Identifier
1386610384
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601004471
- Practice address
- 3350 Gratiot Blvd
Marysville, MI 48040-2121 - Phone
- (810) 364-4000
- Fax
- (810) 364-6623
- NPI assigned
- Feb 28, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601004471 | MI | Primary |
Addresses
Primary practice location
3350 Gratiot Blvd
Marysville, MI 48040-2121
Mailing address
PO Box 610228
Port Huron, MI 48061-0228
Other names 1
- Shannon M Jackson
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601004471 | MI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Henry Ford Health St. John Hospital | Current | Accepting new patients | |
| Henry Ford Health St. John Hospital | Current | Accepting new patients | |
| Family First Health Care Capac PLLC | Past | Accepting new patients |
Locations
22101 Moross Rd
Detroit, MI 48236
Phone (313) 343-3248
Organizations & group practices 5
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1386610384",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 610228",
"city": "PORT HURON",
"state": "MI",
"postal_code": "480610228"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3350 GRATIOT BLVD",
"city": "MARYSVILLE",
"state": "MI",
"postal_code": "480402121",
"telephone_number": "810-364-4000",
"fax_number": "810-364-6623"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROTTMAN",
"first_name": "SHANNON",
"middle_name": "M",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-28",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601004471",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SHANNON",
"last_name": "JACKSON",
"middle_name": "M",
"credential": "PA-C",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Marysville, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.