Shannon Carolyn McCormick, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MA058941 Issued in PA

Practice address

278 Eagleview Blvd
Exton, PA 19341-1157

Phone

(610) 561-6400

NPI assigned

Apr 10, 2017

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

Medicare fee-for-service enrollment

Enrolled in PA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Revive Spine and Pain Center

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Marlton, NJ
  • NPI 1457896003
  NPD (past)

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

{
    "created_epoch": "1491782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491782400000",
    "number": "1497288104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "278 EAGLEVIEW BLVD",
            "city": "EXTON",
            "state": "PA",
            "postal_code": "193411157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "278 EAGLEVIEW BLVD",
            "city": "EXTON",
            "state": "PA",
            "postal_code": "193411157",
            "telephone_number": "610-561-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORMICK",
        "first_name": "SHANNON",
        "middle_name": "CAROLYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-10",
        "last_updated": "2017-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA058941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenna G McBride, OTR/L
• Michael John McCandless, AUD
• Suzanne Einsmann McCann
• Jesse McCartney, DC
• Moira Joyce McCormick
• Christine M McCusker, CRNP
• Heather McDermond
• Michael Joseph McDevitt Jr., PT, DPT
• Nicole T McDevitt, PT, DPT
• Jennifer McDivitt

• Physician Assistant in Exton, PA
• Providers in Exton, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2017; 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.