Shannon Derose, RPA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

012694 Issued in NY

Practice address

125 Red Creek Dr Ste 205
Rochester, NY 14623-4262

Phone

(585) 723-7600

Fax

(585) 334-6373

NPI assigned

Aug 28, 2008

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 Parker Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Western New York Medical Practice PCGroup PAC ID 3870767791, 528 clinicians

Rochester General HospitalGroup PAC ID 0244149474, 1,192 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Rochester General Hospital Hospital, Rochester, NY, CCN 330125

Merit-based Incentive Payment System (MIPS)

Final score

96.62 of 100Reported as apm

Quality

74.51

Promoting interoperability

100

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

96.62 of 100Reported as apm

Quality

74.51

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Western New York Medical Practice P.C.

  • Family Medicine Physician
  • Rochester, NY
  • NPI 1063790608
  Medicare reassignment Care Compare group NPD
• Rochester General Hospital

  dba Rochester General Medical Groups

  • Family Medicine Physician
  • Rochester, NY
  • NPI 1356412712
  Medicare reassignment Care Compare group
• The Unity Hospital of Rochester

  • General Acute Care Hospital
  • Rochester, NY
  • NPI 1760421713
  Medicare reassignment
• Rochester General Hospital

  • General Acute Care Hospital
  • Rochester, NY
  • NPI 1255360517
  NPD
• Rochester General Hospital

  • Multi-Specialty Clinic/Center
  • Rochester, NY
  • NPI 1861568594
  NPD
• The Unity Hospital of Rochester

  dba Unity Physician Services

  • General Acute Care Hospital
  • Rochester, NY
  • NPI 1457395766
  NPD
• Western New York Medical Practice P.C

  dba WNY Eye Care Pittsford

  • Optician
  • Pittsford, NY
  • NPI 1871157503
  NPD

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

{
    "created_epoch": "1219881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663113600000",
    "number": "1407004898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 LONG POND RD",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146264122",
            "telephone_number": "585-723-7281",
            "fax_number": "585-723-8660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 RED CREEK DR STE 205",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146234262",
            "telephone_number": "585-723-7600",
            "fax_number": "585-334-6373"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2115 Chili Ave",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "NY",
            "postal_code": "146243425",
            "country_code": "US",
            "telephone_number": "585-723-7600",
            "fax_number": "585-247-0075",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEROSE",
        "first_name": "SHANNON",
        "credential": "RPA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-28",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "012694",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03607632",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "shannon.derose@rochesterregional.org",
            "affiliation": "N",
            "address_1": "1425 Portland Ave",
            "city": "Rochester",
            "state": "NY",
            "country_code": "US",
            "postal_code": "146213011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "PARKER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Maria A Derosa, RPAC
• Tara A Derosa
• Thomas A Derosa, D.D.S.
• Angel Derose, CASAC
• Patrick A Derose, D.D.S.
• Martha Ellen Derosia, FNP
• Susan M Derrick, RN
• Michelle C Derue, OTD
• Victoria Derue, PNP
• Diane Deruyter, LMHC

• Surgical Physician Assistant in Rochester, NY
• Providers in Rochester, NY by specialty
• Surgical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 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.