Individual provider Active NPI

Shannon Speeg Brown, PA-C, MPH

  • Physician Assistant
  • Baton Rouge, LA
National Provider Identifier
1417358680
Registry record updated Apr 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.200725 Issued in LA
Practice address
8080 Bluebonnet Blvd
Baton Rouge, LA 70810-7827
Phone
(225) 924-2424
Fax
(225) 408-7980
NPI assigned
Sep 8, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA.200725 LA Primary

Addresses

Primary practice location

8080 Bluebonnet Blvd
Baton Rouge, LA 70810-7827

Mailing address

8080 Bluebonnet Blvd
Baton Rouge, LA 70810-7827
Phone (225) 924-2424

Other practice location 1

8200 Constantin Blvd Fl 1
Baton Rouge, LA 70809-3481
Phone (225) 765-5500

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address sspeeg9912@direct.casso.us.com Direct
FHIR URL https://epicproxy.et0830.epihosted.com/FHIRPoxy/api/FHIR/DSTU2/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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
I20141017000065 LA Practitioner - Physician Assistant 5496976367 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA.200725LAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Our Lady of the Lake Physician Group LLC CurrentSince Jan 1, 2015 Accepting new patients
Baton Rouge Orthopaedic Clinic, LLC CurrentSince Sep 15, 2014 Accepting new patients
Baton Rouge Orthopaedic Clinic CurrentSince Sep 15, 2014 Accepting new patients

Locations

8080 Bluebonnet Blvd
Ste 1000
Baton Rouge, LA 70810
Phone (225) 408-6633

8080 Bluebonnet Blvd
Ste 2020
Baton Rouge, LA 70810
Phone (225) 767-2099

8200 Constantin Blvd
Fl 1
Baton Rouge, LA 70809

8080 Bluebonnet Blvd
Baton Rouge, LA 70810
Phone (225) 408-8080

Interoperability endpoints

  • Direct secure messaging: sspeeg9912@direct.casso.us.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1410134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650931200000",
    "number": "1417358680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8080 BLUEBONNET BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708107827",
            "telephone_number": "225-924-2424",
            "fax_number": "225-408-7980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8080 BLUEBONNET BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708107827",
            "telephone_number": "225-924-2424",
            "fax_number": "225-408-7980"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8200 Constantin Blvd Fl 1",
            "address_purpose": "LOCATION",
            "city": "Baton Rouge",
            "state": "LA",
            "postal_code": "708093481",
            "country_code": "US",
            "telephone_number": "225-765-5500",
            "fax_number": "225-374-0501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROWN",
        "first_name": "SHANNON",
        "middle_name": "SPEEG",
        "name_prefix": "Miss",
        "credential": "PA-C, MPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-08",
        "last_updated": "2022-04-26",
        "certification_date": "2022-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "PA.200725",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sspeeg9912@direct.casso.us.com",
            "affiliation": "N",
            "endpointDescription": "FMOLHS-Epic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "sspeeg9912@direct.casso.us.com",
            "address_1": "8200 Constantin Blvd Fl 1",
            "city": "Baton Rouge",
            "state": "LA",
            "country_code": "US",
            "postal_code": "708093481",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0830.epihosted.com/FHIRPoxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FMOLHS FHIR URL",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR  API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "8200 Constantin Blvd Fl 1",
            "city": "Baton Rouge",
            "state": "LA",
            "country_code": "US",
            "postal_code": "708093481",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Baton Rouge, LA

Sources for this page

Verify at the official NPI Registry.