Individual provider Active NPI

Shannon Kelly Evans

  • Neonatal-Perinatal Medicine Physician
  • Louisville, KY
National Provider Identifier
1487953675
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
50218 Issued in KY
Practice address
4123 Dutchmans LN Ste 301
Louisville, KY 40207-4721
Phone
(802) 847-2700
NPI assigned
Mar 28, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 042.0012902 VT
Student in an Organized Health Care Education/Training Program 390200000X
Neonatal-Perinatal Medicine Physician 2080N0001X 50218 KY Primary

Addresses

Primary practice location

4123 Dutchmans LN Ste 301
Louisville, KY 40207-4721

Mailing address

111 Colchester Ave
Burlington, VT 05401-1473
Phone (802) 847-2700

Other names 1

  • Shannon Kelly Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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

Enrollment IDStateProvider typePAC IDDetails
I20170804001013 KY Practitioner - Pediatric Medicine 1658599931 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
042.0012902VTMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Norton Children'S Medical Group, LLC Current Accepting new patients
Norton Children'S Medical Group, LLC Pediatrics CurrentSince Mar 1, 2020 Accepting new patients
Norton Children'S Medical Group, LLC CurrentSince Mar 1, 2020 Accepting new patients
Community Medical Associates, Inc. Current Accepting new patients
Community Medical Associates, Inc. CurrentSince Aug 1, 2017 Accepting new patients
Community Medical Associates, Inc. Pediatrics CurrentSince Aug 1, 2017 Accepting new patients
Baptist Healthcare System Inc. Past Accepting new patients
Norton Childrens Medical Group, LLC Pediatrics Past Accepting new patients
Norton Hospitals, Inc Past Accepting new patients

Locations

1850 State St
New Albany, IN 47150
Phone (812) 944-7701

231 E Chestnut St
Louisville, KY 40202
Phone (502) 852-8500

4123 Dutchmans Ln
Ste 301
Louisville, KY 40207
Phone (502) 896-2500

825 Barret Ave
Louisville, KY 40204
Phone (502) 272-5165

200 E Chestnut St
Louisville, KY 40202
Phone (502) 446-8000

4123 Dutchmans Ln
Ste 606
Louisville, KY 40207
Phone (502) 896-2500

601 S Floyd St
Ste 604
Louisville, KY 40202
Phone (502) 559-1670

411 E Chestnut St
#2
Louisville, KY 40202
Phone (502) 588-0902

4000 Kresge Way
St Matthews, KY 40207
Phone (502) 459-7902

Interoperability endpoints

  • Direct secure messaging: sevans130024@direct.nortonhealthcare.org

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1301270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731283200000",
    "number": "1487953675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 COLCHESTER AVE",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054011473",
            "telephone_number": "802-847-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4123 DUTCHMANS LN STE 301",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074721",
            "telephone_number": "802-847-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "SHANNON",
        "middle_name": "KELLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-28",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VT",
            "license": "042.0012902",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "KY",
            "license": "50218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "KELLY",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.