Shannon Leigh Nicholson, CFNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024167932 Issued in VA

Practice address

19455 Deerfield Ave
Suite 312
Lansdowne, VA 20176-8100

Phone

(703) 729-5010

Fax

(703) 729-5833

NPI assigned

Aug 18, 2008

Last updated

Jun 21, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Shannon Leigh Manger Former name

Medicare fee-for-service enrollment

Enrolled in VA, WV2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The National Sports Medicine Institute,PCGroup PAC ID 5597842096, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• The National Sports Medicine Institute,PC

  • Orthopaedic Surgery Physician
  • Lansdowne, VA
  • NPI 1790815645
  Medicare reassignment Care Compare group NPD
• City Hospital Inc

  dba City Hospital Anesthesia Department

  • Anesthesiology Physician
  • Martinsburg, WV
  • NPI 1942503164
  Medicare reassignment
• Jefferson Memorial Hospital

  dba Jefferson Medical Center

  • Critical Access Hospital
  • Ranson, WV
  • NPI 1891722377
  Medicare reassignment
• National Sports Medicine Institute

  • Physical Therapy Clinic/Center
  • Lansdowne, VA
  • NPI 1447645551
  NPD (past)

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

{
    "created_epoch": "1219017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340236800000",
    "number": "1457507717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19455 DEERFIELD AVE",
            "address_2": "SUITE 312",
            "city": "LANSDOWNE",
            "state": "VA",
            "postal_code": "201768100",
            "telephone_number": "703-729-5010",
            "fax_number": "703-729-5833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19455 DEERFIELD AVE",
            "address_2": "SUITE 312",
            "city": "LANSDOWNE",
            "state": "VA",
            "postal_code": "201768100",
            "telephone_number": "703-729-5010",
            "fax_number": "703-729-5833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "SHANNON",
        "middle_name": "LEIGH",
        "credential": "CFNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-18",
        "last_updated": "2012-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024167932",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1457507717",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "MANGER",
            "middle_name": "LEIGH",
            "credential": "DNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Neurology Consultant Services, P.C.
• Ryan NG, PT, DPT, MPH
• Jane T Nguyen, M.D.
• Loan H Nguyen
• Tracey Nguyen
• Kimberly Lynn Nicoll, M.D.
• Suzanne Elaine Nixon, ED.D.
• Northern Virginia Imaging, LLC
• Northern Virginia Imaging, LLC
• Northland Hearing Centers, Inc. (Ascent Hearing & Audiology)

• Family Nurse Practitioner in Lansdowne, VA
• Providers in Lansdowne, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.