NPIMap

Individual provider Active NPI

Shannon Lee Plos, NP

  • Nurse Practitioner
  • Green Bay, WI
National Provider Identifier
1477911071
Registry record updated Apr 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
6799-33 Issued in WI
Practice address
835 S Van Buren St
Green Bay, WI 54301-3526
Phone
(920) 884-5460
Fax
(920) 884-5475
NPI assigned
Feb 10, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 143070-30 WI
Nurse Practitioner 363L00000X 6799-33 WI Primary

Addresses

Primary practice location

835 S Van Buren St
Green Bay, WI 54301-3526

Mailing address

2793 Lineville Rd
Green Bay, WI 54313-7152
Phone (920) 496-4700

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160509001879 WI Practitioner - Nurse Practitioner 1850690132 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

835 S Van Buren St
Green Bay, WI 54301-3526
Phone (920) 496-4700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
143070-30WIMDRegistered Nurse
6799-33WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prevea Clinic, Inc. CurrentSince Mar 6, 2020 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Apr 25, 2016 Accepting new patients
Prevea Clinic, Inc. CurrentSince Mar 6, 2020 Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Mar 15, 2020 Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis Nurse Practitioner CurrentSince Mar 15, 2020 Accepting new patients
St. Nicholas Hospital-Sisters of the Third Order of St Francis Current Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Apr 25, 2016 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Past Accepting new patients

Locations

1726 Shawano Ave
Green Bay, WI 54303
Phone (920) 432-6016

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

2793 Lineville Rd
Howard, WI 54313

3100 Superior Ave
Sheboygan, WI 53081
Phone (800) 472-6710

Organizations & group practices 8

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 12

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": "1455062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586822400000",
    "number": "1477911071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2793 LINEVILLE RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543137152",
            "telephone_number": "920-496-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 S VAN BUREN ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013526",
            "telephone_number": "920-884-5460",
            "fax_number": "920-884-5475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PLOS",
        "first_name": "SHANNON",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-10",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "143070-30",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "6799-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.