Individual provider Active NPI

Shawneka D Bryan, NP-C

  • Family Nurse Practitioner
  • Lawrenceville, GA
National Provider Identifier
1457609257
Registry record updated Aug 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN148378 Issued in GA
Practice address
1000 Medical Center Blvd
Lawrenceville, GA 30046-7694
Phone
(678) 312-3356
NPI assigned
Aug 27, 2012
Last updated
Aug 27, 2012By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 27, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN148378 GA Primary

Addresses

Primary practice location

1000 Medical Center Blvd
Lawrenceville, GA 30046-7694

Mailing address

3145 Haverhill Rowe
Lawrenceville, GA 30044-3157
Phone (770) 921-4346

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20121022000284 GA Practitioner - Nurse Practitioner 9739339177 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

755 Walther Rd
Lawrenceville, GA 30046-8725
Phone (678) 272-3648

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
76.66 of 100Reported as group
Quality
58.46
Promoting interoperability
83
Improvement activities
40
Cost
77.92

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN148378GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Gwinnett Emergency Specialists, LLC CurrentSince Sep 8, 2012 Accepting new patients
Northside Hospital, Inc. CurrentSince Jun 1, 2021 Accepting new patients
Gwinnett Emergency Specialists Observation Services, LLC CurrentSince Sep 8, 2012 Accepting new patients
Northside CV Professional Services LLC CurrentSince Jun 1, 2021 Accepting new patients
Gwinnett Medical Group, Inc Past Accepting new patients

Locations

3620 Howell Ferry Rd
Duluth, GA 30096
Phone (678) 312-3294

3855 Pleasant Hill Rd
Ste 470
Duluth, GA 30096
Phone (678) 312-7280

1132 Athens Hwy
Ste 207
Grayson, GA 30017
Phone (678) 312-0300

1000 Medical Center Blvd
Lawrenceville, GA 30046
Phone (678) 312-3356

755 Walther Rd
Lawrenceville, GA 30046

Organizations & group practices 5

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 3

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": "1346025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346025600000",
    "number": "1457609257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3145 HAVERHILL ROWE",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300443157",
            "telephone_number": "770-921-4346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 MEDICAL CENTER BLVD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300467694",
            "telephone_number": "678-312-3356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRYAN",
        "first_name": "SHAWNEKA",
        "middle_name": "D",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-27",
        "last_updated": "2012-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN148378",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.