Shannon Irwin, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

298870 Issued in CA

Practice address

2322 Powell St
Emeryville, CA 94608-1738

Phone

(510) 653-5151

NPI assigned

Sep 30, 2020

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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Stac Physical Therapy Emeryville IncGroup PAC ID 3971853938, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Stac Physical Therapy Emeryville, Inc.

  dba Emeryville Sports Physical Therapy

  • Orthopedic Physical Therapist
  • Emeryville, CA
  • NPI 1326527730
  Medicare reassignment Care Compare group NPD
• West Coast Spine Restoration Center, Inc

  • Physical Therapist
  • Riverside, CA
  • NPI 1992887616
  Medicare reassignment NPD

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

{
    "created_epoch": "1601424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658275200000",
    "number": "1407463680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21132 GARDEN AVE",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945414816",
            "telephone_number": "925-413-5110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2322 POWELL ST",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946081738",
            "telephone_number": "510-653-5151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IRWIN",
        "first_name": "SHANNON",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-30",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "298870",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPY",
            "identifier": "298870",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chioma Stella Ikechukwu
• Independent Mobility, LLC (Easy Riders)
• Interact Behavior, LLC (Interact Behavior Consulting)
• International Global Enterprises, Inc.
• Catherine Ehibhajejemen Iretekhale, FNP, DNP
• Shondrae Ivy
• Samantha L Jackson
• Ryan Daniel Jakes
• Babak Jahromi Jamasbi, M.D.
• Davonna Denise James

• Physical Therapist in Emeryville, CA
• Providers in Emeryville, CA by specialty
• Physical Therapist in California

• 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.
• 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.