Active NPI
Shannon Marie Dickson, LMP
- Specialist
- Bellevue, WA
National Provider Identifier
1407291578
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 603275027
- Practice address
- 1400 112TH Ave SE
Suite 100
Bellevue, WA 98004-6901 - Phone
- (425) 223-3712
- NPI assigned
- May 2, 2013
- Last updated
- Jan 17, 2014
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Specialist | 174400000X | 603275027 | WA | Primary |
Addresses
Primary practice location
1400 112TH Ave SE
Suite 100
Bellevue, WA 98004-6901
Mailing address
1400 112TH Ave SE
Suite 100
Bellevue, WA 98004-6901
Phone (425) 223-3712
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 603275027 | WA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1367452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389916800000",
"number": "1407291578",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 112TH AVE SE",
"address_2": "SUITE 100",
"city": "BELLEVUE",
"state": "WA",
"postal_code": "980046901",
"telephone_number": "425-223-3712"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 112TH AVE SE",
"address_2": "SUITE 100",
"city": "BELLEVUE",
"state": "WA",
"postal_code": "980046901",
"telephone_number": "425-223-3712"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKSON",
"first_name": "SHANNON",
"middle_name": "MARIE",
"credential": "LMP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-05-02",
"last_updated": "2014-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WA",
"license": "603275027",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bellevue, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.