NPIMap

Individual provider Active NPI

Shana S. Standard, PA

  • Physician Assistant
  • Savannah, GA
National Provider Identifier
1417977562
Registry record updated Oct 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
003540 Issued in GA
Practice address
527 Eisenhower Dr
Savannah, GA 31406-2668
Phone
(912) 819-9100
Fax
(912) 819-9101
NPI assigned
Jul 20, 2006
Last updated
Oct 23, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 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 003540 GA Primary

Addresses

Primary practice location

527 Eisenhower Dr
Savannah, GA 31406-2668

Mailing address

836 E. 65TH Street
Suite 22
Savannah, GA 31405
Phone (912) 819-7878

Other identifiers 3

IdentifierTypeStateIssuer
P00610133OtherGARR MEDICARE
01270783OtherAMERIGROUP
100000855CMedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080710000058 GA Practitioner - Physician Assistant 0648342543 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
SJC Medical Group IncGroup PAC ID 7719978105, 57 clinicians

Practice addresses (Care Compare)

11705 Mercy Blvd
Savannah, GA 31419-1711
Phone (912) 819-4949

527 Eisenhower Dr
Savannah, GA 31406-2668
Phone (912) 819-9100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3540GAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Optim Orthopedics, LLC CurrentSince Apr 1, 2015 Accepting new patients
Privia Medical Group of Georgia LLC CurrentSince Mar 31, 2020 Accepting new patients
Optim Orthopedics, LLC CurrentSince Apr 1, 2015 Accepting new patients
Optim Orthopedics, LLC Past Accepting new patients
Optim Orthopedics, LLC PastSince Oct 6, 2019 Accepting new patients

Locations

101 Yorktown Dr
Ste 100
Fayetteville, GA 30214
Phone (770) 460-4285

210 E Derenne Ave
Savannah, GA 31405
Phone (912) 355-0140

340 Eisenhower Dr
Ste 1200
Savannah, GA 31406
Phone (912) 443-4200

Interoperability endpoints

  • Direct secure messaging: shana.standard@sjcmg.eclinicaldirectplus.com
  • Direct secure messaging: shanastandard@bcgmg.allscriptsdirect.net
  • Direct secure messaging: standards@direct.sjchs.org

Organizations & group practices 8

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 2

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": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729641600000",
    "number": "1417977562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "836 E. 65TH STREET",
            "address_2": "SUITE 22",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "31405",
            "telephone_number": "912-819-7878",
            "fax_number": "912-819-3320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "527 EISENHOWER DR",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314062668",
            "telephone_number": "912-819-9100",
            "fax_number": "912-819-9101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANDARD",
        "first_name": "SHANA",
        "middle_name": "S.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-20",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "003540",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00610133",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "01270783",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100000855C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Savannah, GA

Sources for this page

Verify at the official NPI Registry.