Shannon Shan Joseph, M.D.

Primary specialty

Ophthalmic Plastic and Reconstructive Surgery PhysicianTaxonomy code 207WX0200X

License

4301104534 Issued in MI

Practice address

3940 John R Rd
Troy, MI 48083-5688

Phone

(248) 455-4169

NPI assigned

Apr 4, 2010

Last updated

Jul 20, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Shannon Shan Former name

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Ophthalmology

Education

Johns Hopkins University School of Medicine, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Joseph Advanced Facial Plastic Surgery, PLLCGroup PAC ID 3870970866, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Beaumont Hospital, Troy Hospital, Troy, MI, CCN 230269
• Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sshan450143@direct.med.umich.edu

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.

• Joseph Advanced Facial Plastic Surgery, PLLC

  dba JOSEPH Advanced Oculofacial Plastic Surgery

  • Ophthalmic Plastic and Reconstructive Surgery Physician
  • Troy, MI
  • NPI 1154082428
  Medicare reassignment Care Compare group NPD Authorized official
• Ompt Specialists, Inc.

  • Physical Therapist
  • Troy, MI
  • NPI 1205865961
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• William Beaumont Hospital

  dba Beaumont Hospital, Troy

  • General Acute Care Hospital
  • Troy, MI
  • NPI 1306825997
  Care Compare affiliation
• William Beaumont Hospital

  dba Beaumont Hospital, Royal Oak

  • General Acute Care Hospital
  • Royal Oak, MI
  • NPI 1689653305
  Care Compare affiliation
• William Beaumont Hospital

  dba Beaumont Hospital, Grosse Pointe

  • General Acute Care Hospital
  • Grosse Pointe, MI
  • NPI 1932396017
  Care Compare affiliation

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

{
    "created_epoch": "1270339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658275200000",
    "number": "1396060224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3940 JOHN R RD",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480835688",
            "telephone_number": "947-217-3223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3940 JOHN R RD",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480835688",
            "telephone_number": "248-455-4169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOSEPH",
        "first_name": "SHANNON",
        "middle_name": "SHAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-04",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MD",
            "license": "D81623",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": "4301104534",
            "primary": false
        },
        {
            "code": "207WX0200X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery",
            "state": "MI",
            "license": "4301104534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "SHAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Daizen Joseph- Chacko, NP
• Andrew William Joseph, M.D.
• John Robert Joseph, M.D.
• Kalappurackal Chacko Joseph, MD
• Marylou Joseph, PTA
• Josephine Iskander, MD PLLC
• Josette M. Lucci LLC
• Journey Life Counseling, LLC
• Melissa Marie Jovick, MA. LLPC, PHR
• Joy Counseling Services PLLC

• Ophthalmic Plastic and Reconstructive Surgery Physician in Troy, MI
• Providers in Troy, MI by specialty
• Ophthalmic Plastic and Reconstructive Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2022; 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.