Shannon Dawn Chain, MD
Individual provider Active NPI Physical Medicine & Rehabilitation Physician · Petaluma, CA
NPI 1447575428 · NPPES record last updated Jan 10, 2022
Key facts
- NPI
- 1447575428
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Medicine & Rehabilitation Physician 208100000X
- License
- MD166551 (OR)
- Practice address
- 346 Lakeville Cir
Petaluma, CA 94954-5723 - Phone
- (628) 233-3013
- NPI assigned
- Apr 1, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Physical Medicine and Rehabilitation
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Permanente Medical Group Inc
Practice addresses (Care Compare)
99 Montecillo Rd
San Rafael, CA 94903-3308
Phone (415) 444-2000
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160405000494 | CA | Practitioner - Physical Medicine and Rehabilitation | 2264650837 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A140657 | CA | MD | Physical Medicine & Rehabilitation Physician |
| MD166551 | OR | MD | Physical Medicine & Rehabilitation Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Enloe Medical Center | Physical Medicine & Rehabilitation | Current |
Accepting new patients |
| Permanente Medical Group Inc | Physical Medicine & Rehabilitation | Current |
Accepting new patients |
| Permanente Medical Group Inc | Physical Medicine & Rehabilitation | Current | Accepting new patients |
| Permanente Medical Group, Inc | Current |
Accepting new patients | |
| Enloe Medical Center | Current |
Accepting new patients |
Locations
750 Auburn Ravine Rd
Auburn, CA 95603
Phone (530) 823-6131
340 W East Ave
Chico, CA 95926
Phone (530) 332-6138
4753 W Shaw Ave
Ste 101
Fresno, CA 93722
Phone (559) 277-8738
900 N Douty St
Hanford, CA 93230
Phone (559) 587-9014
1800 Harrison St
Fl 7
Oakland, CA 94612
101 Monroe St
Petaluma, CA 94954
Phone (707) 763-4109
1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015
901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500
930 W Main St
Ripon, CA 95366
Phone (209) 599-4221
501 J St
Sacramento, CA 95814
Phone (916) 497-3000
2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000
99 Montecillo Rd
San Rafael, CA 94903
Phone (415) 444-2047
234 N San Pedro Rd
San Rafael, CA 94903
Phone (415) 479-3450
710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400
5615 Scotts Valley Dr
Scotts Valley, CA 95066
Phone (831) 430-2700
7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000
975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000
1224 Rossmoor Pkwy
Walnut Creek, CA 94595
Phone (925) 937-7450
320 N Crawford St
Willows, CA 95988
Phone (530) 934-2834
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | A140657 | CA | |
| Physical Medicine & Rehabilitation Physician | 208100000X | MD166551 | OR | Yes |
Addresses
Primary practice location
346 Lakeville Cir
Petaluma, CA 94954-5723
Mailing address
346 Lakeville Cir
Petaluma, CA 94954-5723
Phone (628) 233-3013
Other practice location 1
2780 E Barnett Rd
Medford, OR 97504-8674
Phone (541) 776-5065
Other names
- Shannon Dawn Dietzmann
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq | Health Information Exchange (HIE) | The Permanente Medical Group |
Other providers in Petaluma, CA
- Centerwell Certified Healthcare Corp
- Alejandra Cerna
- Guadalupe Chabriel
- Adriana Chacon-Kreysa
- Aimee C Chagnon
- Sherin Ann Chakkalakel
- Adrian Zhiwen Chan
- Von Chan
- Kevin Chang
- Channel Medical Group of California, P.C.
All providers in Petaluma, CA · Physical Medicine & Rehabilitation Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 10, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.