NPIMap

Individual provider Active NPI

Shannon Smith, PA-C

  • Physician Assistant
  • Woodbury, MN
National Provider Identifier
1417792912
Registry record updated Oct 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
8675 Valley Creek Rd
Woodbury, MN 55125-2337
Phone
(651) 241-3000
NPI assigned
Jun 26, 2024
Last updated
Oct 30, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 30, 2024

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 Primary

Addresses

Primary practice location

8675 Valley Creek Rd
Woodbury, MN 55125-2337

Mailing address

8675 Valley Creek Rd
Woodbury, MN 55125-2337
Phone (651) 241-3000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ssmith671339@excellian.direct.allina.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240801000817 MN Practitioner - Physician Assistant 2365989910 Reassigns benefits to 1 organization
I20240821000764 WI Practitioner - Physician Assistant 2365989910 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians

Practice addresses (Care Compare)

1155 County Rd E E
Vadnais Heights, MN 55110-5191
Phone (612) 775-6200

2805 Campus Dr
Suite 205
Plymouth, MN 55441-2678
Phone (763) 577-7200

440 Elm St E
Annandale, MN 55302-1109
Phone (320) 682-5225

8675 Valley Creek Rd
Woodbury, MN 55125-2337
Phone (651) 241-3000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System CurrentSince Aug 26, 2024 Accepting new patients
Allina Health System CurrentSince Aug 26, 2024 Accepting new patients
Allina Health System CurrentSince Aug 26, 2024 Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

8675 Valley Creek Rd
Woodbury, MN 55125
Phone (651) 241-3000

1617 E Division St
River Falls, WI 54022
Phone (715) 307-6600

1629 E Division St
River Falls, WI 54022
Phone (715) 307-6000

Interoperability endpoints

  • Direct secure messaging: ssmith671339@excellian.direct.allina.com

Organizations & group practices 5

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.

Hospital & facility affiliations 41

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

View all 41

NPI Registry JSON

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

{
    "created_epoch": "1719360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1417792912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8675 VALLEY CREEK RD",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252337",
            "telephone_number": "651-241-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8675 VALLEY CREEK RD",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252337",
            "telephone_number": "651-241-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SHANNON",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-26",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ssmith671339@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "8675 Valley Creek Rd",
            "city": "Woodbury",
            "state": "MN",
            "country_code": "US",
            "postal_code": "551252337",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Woodbury, MN

Sources for this page

Verify at the official NPI Registry.