Active NPI
Jill Shannahan, M.D.
- Psychiatry Physician
- Santa Cruz, CA
National Provider Identifier
1467516005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- G83206
- Practice address
- 1400 Emeline Ave
Santa Cruz, CA 95060-1976 - Phone
- (831) 454-4170
- Fax
- (831) 454-4663
- NPI assigned
- Dec 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | G83206 | CA | Primary |
Addresses
Primary practice location
1400 Emeline Ave
Santa Cruz, CA 95060-1976
Mailing address
1400 Emeline Ave
Santa Cruz, CA 95060-1976
Phone (831) 454-4170
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G832061 | Medicaid | CA | |
| ZZZ91891Z | Other | CA | MEDICARE GROUP ID# |
| ZZZ92069Z | Other | CA | MEDICARE GROUP ID# |
| G83206 | Other | CA | MEDICAL LICENSE# |
| ZZZ91892Z | Other | CA | MEDICARE GROUP ID# |
| ZZZ92073Z | Other | CA | MEDICARE GROUP ID# |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G83206 | CA | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Puentes Al Sur | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Adult Mental Health Clinic/Center
- Watsonville, CA
- NPI 1992849012
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1467516005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 EMELINE AVE",
"city": "SANTA CRUZ",
"state": "CA",
"postal_code": "950601976",
"telephone_number": "831-454-4170",
"fax_number": "831-454-4663"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 EMELINE AVE",
"city": "SANTA CRUZ",
"state": "CA",
"postal_code": "950601976",
"telephone_number": "831-454-4170",
"fax_number": "831-454-4663"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANNAHAN",
"first_name": "JILL",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-20",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "G83206",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G832061",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP ID#",
"identifier": "ZZZ91891Z",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP ID#",
"identifier": "ZZZ92069Z",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE#",
"identifier": "G83206",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP ID#",
"identifier": "ZZZ91892Z",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP ID#",
"identifier": "ZZZ92073Z",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Santa Cruz, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.