Individual provider Active NPI

Shannon R Mayhew, CRNA

  • Certified Registered Nurse Anesthetist
  • Grand Rapids, MI
National Provider Identifier
1437410164
Registry record updated Jul 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704246200 Issued in MI
Practice address
3333 Evergreen Dr NE
Grand Rapids, MI 49525-9493
Phone
(616) 364-4200
Fax
(616) 364-7347
NPI assigned
May 29, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 4704246200 MI Primary

Addresses

Primary practice location

3333 Evergreen Dr NE
Grand Rapids, MI 49525-9493

Mailing address

3333 Evergreen Dr NE
Grand Rapids, MI 49525-9493
Phone (616) 364-4200

Other names 1

  • Shannon Leonard Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120823000610 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 6002063252 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West Michigan Anesthesia PCGroup PAC ID 1355243551, 69 clinicians
Anesthesia Medical Consultants, PCGroup PAC ID 3678751658, 87 clinicians

Practice addresses (Care Compare)

3333 Evergeen Dr NE
Grand Rapids, MI 49525-9493
Phone (616) 364-4200

4055 Cascade Rd SE
Metro Health Park East Outpatient Surgical
Grand Rapids, MI 49546-2149
Phone (616) 364-4200

5900 Byron Ctr Ave SW
Metro Health Hospital
Wyoming, MI 49519-9606
Phone (616) 364-4200

Hospital & facility affiliations

  • University of Michigan Health - West Hospital, Wyoming, MI, CCN 230236

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia Medical Consultants, PC CurrentSince Jan 20, 2014 Accepting new patients

Locations

310 Lafayette Ave SE
Ste 400
Grand Rapids, MI 49503
Phone (616) 752-6525

310 Lafayette Ave SE
Ste 4
Grand Rapids, MI 49503
Phone (616) 752-6525

3333 Evergreen Dr NE
Grand Rapids, MI 49525
Phone (616) 284-3132

310 Lafayette Ave SE
Ste 40
Grand Rapids, MI 49503
Phone (616) 752-6525

4055 Cascade Rd SE
Grand Rapids, MI 49546
Phone (616) 252-4410

310 Lafayette Ave SE
Grand Rapids, MI 49503
Phone (616) 685-3450

5900 Byron Center Ave SW
Wyoming, MI 49519
Phone (616) 252-3243

Organizations & group practices 2

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 1

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": "1338249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404345600000",
    "number": "1437410164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259493",
            "telephone_number": "616-364-4200",
            "fax_number": "616-364-7347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259493",
            "telephone_number": "616-364-4200",
            "fax_number": "616-364-7347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYHEW",
        "first_name": "SHANNON",
        "middle_name": "R",
        "name_prefix": "Ms.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-29",
        "last_updated": "2014-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704246200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "LEONARD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2014; 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.