Individual provider Active NPI

Tracey Leah Shannon, N.P.

  • Adult Health Nurse Practitioner
  • Hawthorne, NY
National Provider Identifier
1457580839
Registry record updated Nov 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
305147 Issued in NY
Practice address
19 Bradhurst Ave Ste 3850S
Hawthorne, NY 10532
Phone
(914) 909-6900
Fax
(914) 493-2828
NPI assigned
Jul 7, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 305147 NY Primary

Addresses

Primary practice location

19 Bradhurst Ave Ste 3850S
Hawthorne, NY 10532

Mailing address

19 Bradhurst Ave Ste 3100N
Hawthorne, NY 10532-2140
Phone (914) 909-9018

Other practice location 1

520 E 70th St
Starr 425
New York, NY 10021-9800
Phone (212) 746-4857

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Tracy.Shannon@wmchealth.cernerdirect.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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 1

Enrollment IDStateProvider typePAC IDDetails
I20110112000853 NY Practitioner - Nurse Practitioner 7810186475 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Westchester Medical Center Advanced Physician Services PCGroup PAC ID 3173660776, 879 clinicians

Practice addresses (Care Compare)

95 Grasslands Rd
Valhalla, NY 10595-1652
Phone (914) 493-6940

Hospital & facility affiliations

  • Westchester Medical Center Hospital, Valhalla, NY, CCN 330234

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
305147NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Westchester Medical Center Advanced Physician Services, PC CurrentSince Nov 29, 2018 Accepting new patients
Westchester Medical Center Advanced Physician Services PC CurrentSince Nov 29, 2018 Accepting new patients

Locations

19 Bradhurst Ave
Ste 3850S
Hawthorne, NY 10532
Phone (914) 345-1313

19 Bradhurst Ave
Ste 3100N
Hawthorne, NY 10532
Phone (914) 231-8373

95 Grasslands Rd
Valhalla, NY 10595
Phone (914) 493-2961

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: tracy.shannon@wmchealth.cernerdirect.com

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": "1246924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637625600000",
    "number": "1457580839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 BRADHURST AVE STE 3100N",
            "city": "HAWTHORNE",
            "state": "NY",
            "postal_code": "105322140",
            "telephone_number": "914-909-9018",
            "fax_number": "914-909-9028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 BRADHURST AVE STE 3850S",
            "city": "HAWTHORNE",
            "state": "NY",
            "postal_code": "10532",
            "telephone_number": "914-909-6900",
            "fax_number": "914-493-2828"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "520 E 70th St",
            "address_2": "Starr 425",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100219800",
            "country_code": "US",
            "telephone_number": "212-746-4857",
            "fax_number": "212-746-6951",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "TRACEY",
        "middle_name": "LEAH",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-07",
        "last_updated": "2021-11-23",
        "certification_date": "2021-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "305147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Tracy.Shannon@wmchealth.cernerdirect.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "19 Bradhurst Ave Ste 3850S",
            "city": "Hawthorne",
            "state": "NY",
            "country_code": "US",
            "postal_code": "10532",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hawthorne, NY

Sources for this page

Verify at the official NPI Registry.