Individual provider Active NPI

Shannon Lynne Johnson, NP-C

  • Adult Health Nurse Practitioner
  • East Boston, MA
National Provider Identifier
1417158296
Registry record updated Feb 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
262820 Issued in MA
Practice address
10 Gove St
East Boston, MA 02128-1920
Phone
(617) 569-5800
Fax
(617) 568-4780
NPI assigned
May 30, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 262820 MA Primary

Addresses

Primary practice location

10 Gove St
East Boston, MA 02128-1920

Mailing address

10 Gove St
East Boston, MA 02128-1920
Phone (617) 569-5800

Other identifiers 1

IdentifierTypeStateIssuer
0714810MedicaidMA

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20070926000320 MA Practitioner - Nurse Practitioner 5597859272 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1350 Market St
Lynnfield, MA 01940-4048
Phone (781) 213-4050

15 Railroad Ave
South Hamilton, MA 01982-2218
Phone (978) 468-7381

305 Gloucester Crossing Rd
Gloucester, MA 01930-2283
Phone (978) 304-8380

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Beth Israel Lahey Health Primary Care, Inc. CurrentSince Oct 21, 2019 Accepting new patients
Beth Israel Lahey Health Primary Care Inc CurrentSince Oct 21, 2019 Accepting new patients
Internal Medical Associates-Ebnhc CurrentSince Sep 11, 2007 Accepting new patients
Neighborhealth Corporation CurrentSince Mar 1, 2013 Accepting new patients

Locations

41 Mall Rd
Burlington, MA 01805
Phone (781) 744-8400

480 Maple St
Danvers, MA 01923
Phone (978) 304-8380

10 Grove St
East Boston, MA 02128
Phone (617) 569-5800

15 Railroad Ave
South Hamilton, MA 01982
Phone (978) 468-7381

Interoperability endpoints

  • Direct secure messaging: sjohnson134000@direct.bilh.masshiway.net
  • FHIR API: https://api.platform.athenahealth.com/10729/brand/1/csg/1/fhir/r4

Organizations & group practices 4

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328054400000",
    "number": "1417158296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 GOVE ST",
            "city": "EAST BOSTON",
            "state": "MA",
            "postal_code": "021281920",
            "telephone_number": "617-569-5800",
            "fax_number": "617-568-4780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 GOVE ST",
            "city": "EAST BOSTON",
            "state": "MA",
            "postal_code": "021281920",
            "telephone_number": "617-569-5800",
            "fax_number": "617-568-4780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SHANNON",
        "middle_name": "LYNNE",
        "name_prefix": "Ms.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-30",
        "last_updated": "2012-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MA",
            "license": "262820",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0714810",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Boston, MA

Sources for this page

Verify at the official NPI Registry.