Shannon K Idzik, CRNP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

R131534 Issued in MD

Practice address

655 W Lombard St
345
Baltimore, MD 21201-1512

Phone

(410) 706-8129

Fax

(410) 706-0344

NPI assigned

Aug 30, 2005

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 names 1

• Shannon K Reedy Former name

Medicare fee-for-service enrollment

Enrolled in MD

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

Specialty

Nurse Practitioner

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Upper Chesapeake Primary Care,LLCGroup PAC ID 3476637737, 17 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sidzik87628@direct.umm.edu

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.

• Upper Chesapeake Primary Care,LLC

  • Internal Medicine Physician
  • Bel Air, MD
  • NPI 1093902793

  MD

  Medicare reassignment Care Compare group NPD
• University of Maryland Anesthesiology Associates, P.a.

  • Anesthesiology Physician
  • Baltimore, MD
  • NPI 1720024235

  MD

  Medicare reassignment NPD
• Union Memorial Hospital

  • Multi-Specialty Clinic/Center
  • Baltimore, MD
  • NPI 1336163781
  NPD (past)

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

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294617600000",
    "number": "1467445924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 W LOMBARD ST",
            "address_2": "345",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011512",
            "telephone_number": "410-706-8129",
            "fax_number": "410-706-0344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 W LOMBARD ST",
            "address_2": "345",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011512",
            "telephone_number": "410-706-8129",
            "fax_number": "410-706-0344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDZIK",
        "first_name": "SHANNON",
        "middle_name": "K",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-30",
        "last_updated": "2011-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MD",
            "license": "R131534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "REEDY",
            "middle_name": "K",
            "credential": "CRNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ideal Wellness LLC
• Kyana Monique Idi, PA-C
• Jeffrey Stephen Iding, M.D.
• Ahmed Idrees
• Cynthia Lynn Idzik-Starr, D.D.S.
• Genevieve Ifeanyichukwu, NP
• Iflp Lives LLC
• Elvine Zita Ndongmo Ifoue, RN
• Ruth Malka Ifrah, APRN, FNP-C
• Mustafa Iftikhar, MD

• All providers in Baltimore, MD
• Primary Care Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2011; 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.