Shannon Christine Roberts, MD FACOG

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

6698A Issued in WY

Practice address

555 E Broadway Ave
Ste 108
Jackson, WY 83001-8640

Phone

(307) 734-1005

Fax

(307) 734-1165

NPI assigned

May 17, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Shannon Christine Luis Other name

Medicare fee-for-service enrollment

Enrolled in WY

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

Obstetrics/Gynecology

Education

Other, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gros Ventre OB-GYN LLPGroup PAC ID 2466541693, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Johns Medical Center Hospital, Jackson, WY, CCN 530015

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/4ea2101b-bb2d-4211-bc53-3120cb72bcc5/

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.

• Gros Ventre OB/GYN, LLP

  • Obstetrics & Gynecology Physician
  • Jackson, WY
  • NPI 1649451907
  Medicare reassignment Care Compare group NPD
• Teton County Hospital District

  • General Acute Care Hospital
  • Jackson, WY
  • NPI 1801835475
  NPD (past)
• Frances Mahon Deaconess Hospital

  • Critical Access Hospital
  • Glasgow, MT
  • NPI 1689685323
  NPD (past)

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

• Teton County Hospital District

  • General Acute Care Hospital
  • Jackson, WY
  • NPI 1801835475
  Care Compare affiliation

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355356800000",
    "number": "1396797239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1844",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830011844",
            "telephone_number": "307-734-1005",
            "fax_number": "307-734-1165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 E BROADWAY AVE",
            "address_2": "STE 108",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830018640",
            "telephone_number": "307-734-1005",
            "fax_number": "307-734-1165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "SHANNON",
        "middle_name": "CHRISTINE",
        "credential": "MD FACOG",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-17",
        "last_updated": "2012-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WY",
            "license": "6698A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117467300",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "LUIS",
            "middle_name": "CHRISTINE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• RJ Smiles, LLC
• Roadrunner Apothecary, LLC
• Robert J Brock MD PC
• Chad Roberts, O.D.
• Mary Maureen Roberts
• Lisa G Robertson, OT
• Michelle Robertson
• Chelsea Robin
• Tina Shive Romaine, RN
• Lesley Beus Romero

• Obstetrics & Gynecology Physician in Jackson, WY
• Providers in Jackson, WY by specialty
• Obstetrics & Gynecology Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2012; 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.