NPIMap

Individual provider Active NPI

Shannon Eller Watts, PA-C

  • Physician Assistant
  • Annapolis, MD
National Provider Identifier
1457635526
Registry record updated Oct 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C04573 Issued in MD
Practice address
2002 Medical Pkwy Ste 500
Annapolis, MD 21401-3268
Phone
(410) 573-6480
Fax
(410) 573-9413
NPI assigned
Oct 6, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C04573 MD Primary

Addresses

Primary practice location

2002 Medical Pkwy Ste 500
Annapolis, MD 21401-3268

Mailing address

106 Irving St NW Ste 2700N
Washington, DC 20010-2927
Phone (202) 723-5524

Other names 1

  • Mrs. Shannon Renee Eller Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140904000776 MD Practitioner - Physician Assistant 0446478481 Reassigns benefits to 2 organizations
I20250826004698 DC Practitioner - Physician Assistant 0446478481 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Medstar Heart Institute LLCGroup PAC ID 5698932960, 308 clinicians
Medstar Medical Group II LLCGroup PAC ID 0547413825, 3,726 clinicians

Practice addresses (Care Compare)

106 Irving St NW
Washington, DC 20010-2927
Phone (202) 877-6925

110 Irving St NW
Washington, DC 20010-3017
Phone (202) 877-7000

1406 Crain S Hwy 106
Glen Burnie, MD 21061-4086
Phone (410) 768-6440

2002 Medical Pkwy
Suite 500
Annapolis, MD 21401-3268
Phone (410) 573-6480

3333 N Calvert St
Baltimore, MD 21218-2867
Phone (410) 261-8500

4660 Wilkens Ave
Suite 100
Baltimore, MD 21229-4899
Phone (410) 247-0782

Hospital & facility affiliations

  • Luminis Health Anne Arundel Medical Center, Inc Hospital, Annapolis, MD, CCN 210023
  • University of MD Shore Medical Center at Easton Hospital, Easton, MD, CCN 210037
  • Medstar Washington Hospital Center Hospital, Washington, DC, CCN 090011
  • University of MD Shore Medical Ctr at Chestertown Hospital, Chestertown, MD, CCN 210030

Merit-based Incentive Payment System (MIPS)

Final score
79.87 of 100Reported as group
Quality
58.83
Promoting interoperability
100
Improvement activities
40
Cost
74.06

Merit-based Incentive Payment System (MIPS)

Final score
85.94 of 100Reported as group
Quality
66.29
Promoting interoperability
100
Improvement activities
40
Cost
74.65

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
C04573MDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Medstar Medical Group II LLC Past Accepting new patients

Organizations & group practices 3

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 7

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": "1317859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317859200000",
    "number": "1457635526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 IRVING ST NW STE 2700N",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200102927",
            "telephone_number": "202-723-5524",
            "fax_number": "202-291-0512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 MEDICAL PKWY STE 500",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214013268",
            "telephone_number": "410-573-6480",
            "fax_number": "410-573-9413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATTS",
        "first_name": "SHANNON",
        "middle_name": "ELLER",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-06",
        "last_updated": "2011-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C04573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "ELLER",
            "middle_name": "RENEE",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Annapolis, MD

Sources for this page

Verify at the official NPI Registry.