Individual provider Active NPI

Lisa Shannon, RN

  • Certified Registered Nurse Anesthetist
  • Cincinnati, OH
National Provider Identifier
1396732848
Registry record updated Dec 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
162443 Issued in OH
Practice address
2139 Auburn Ave
Cincinnati, OH 45219-2906
Phone
(513) 672-3309
Fax
(513) 672-3323
NPI assigned
Sep 30, 2005
Last updated
Dec 23, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 162443 OH Primary

Addresses

Primary practice location

2139 Auburn Ave
Cincinnati, OH 45219-2906

Mailing address

11490 Springfield Pike
Cincinnati, OH 45246-3524
Phone (513) 672-3309

Other identifiers 1

IdentifierTypeStateIssuer
0783380MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130509000195 OH Practitioner - Certified Registered Nurse Anesthetist (Crna) 4880796804 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse, Registered Nurse

State licenses

LicenseStateTypeSpecialty
162443OHMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Ogi Anesthesia, LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2015 Accepting new patients
Daniel L French PSC Past Accepting new patients

Locations

11333 Cornell Park Dr
Ste 100
Blue Ash, OH 45242
Phone (513) 569-1355

2925 Vernon Pl
Ste 101
Cincinnati, OH 45219
Phone (513) 872-4541

7360 Liberty One Dr
Ste 332
Liberty Township, OH 45044

4746 Montgomery Rd
Ste 100
Norwood, OH 45212
Phone (513) 569-1310

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1419292800000",
    "number": "1396732848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11490 SPRINGFIELD PIKE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452463524",
            "telephone_number": "513-672-3309",
            "fax_number": "513-672-3323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2139 AUBURN AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452192906",
            "telephone_number": "513-672-3309",
            "fax_number": "513-672-3323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "LISA",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-30",
        "last_updated": "2014-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OH",
            "license": "162443",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0783380",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.