Timothy Ray Shann, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

21817 Issued in OK

Practice address

509 Brookman Dr
Brookhaven, MS 39601-2326

Phone

(601) 823-5204

Fax

(601) 833-1224

NPI assigned

Apr 19, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/6393/brand/1/csg/41/fhir/r4

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.

• KDMC Physician Clinics LLC

  • Multi-Specialty Clinic/Center
  • Brookhaven, MS
  • NPI 1861739161
  Medicare reassignment NPD
• Kings Daughters Medical Center

  • Anesthesiology Physician
  • Brookhaven, MS
  • NPI 1043245368
  Medicare reassignment NPD
• King'S Daughters Medical Center

  • Durable Medical Equipment & Medical Supplies
  • Brookhaven, MS
  • NPI 1881476364
  NPD
• King'S Daughters Medical Center

  • General Acute Care Hospital
  • Brookhaven, MS
  • NPI 1972503464
  NPD

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477353600000",
    "number": "1477518793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 BROOKMAN DR",
            "city": "BROOKHAVEN",
            "state": "MS",
            "postal_code": "396012326",
            "telephone_number": "601-823-5204",
            "fax_number": "601-833-1224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 BROOKMAN DR",
            "city": "BROOKHAVEN",
            "state": "MS",
            "postal_code": "396012326",
            "telephone_number": "601-823-5204",
            "fax_number": "601-833-1224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANN",
        "first_name": "TIMOTHY",
        "middle_name": "RAY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-19",
        "last_updated": "2016-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OK",
            "license": "21817",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNICARE",
            "identifier": "731310891006",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE SOUTH",
            "identifier": "731310891028",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100253110A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOONER PCP",
            "identifier": "100253110A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS (WPS)",
            "identifier": "74502A041",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ryleigh Sampey
• Jodie Lynette Sartin, NP
• Serenity House Adult Day Health Services, Inc.
• Joey Kim Sessums, D.M.D.
• Joey Kim Sessums, M.D.
• Dana Shoemake
• Silver Cross Home
• Silver Cross Home
• Simmons Eye Clinic, LLC.
• Eugene Ainsworth Simmons Jr., M.D.

• Pediatrics Physician in Brookhaven, MS
• Providers in Brookhaven, MS by specialty
• Pediatrics Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.