Individual provider Active NPI

Shannon Williams, PA-C

  • Physician Assistant
  • Philadelphia, PA
National Provider Identifier
1497521330
Registry record updated Dec 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA065259 Issued in PA
Practice address
3400 Spruce St
Philadelphia, PA 19104-4238
Phone
(215) 662-4000
NPI assigned
Dec 1, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA065259 PA Primary

Addresses

Primary practice location

3400 Spruce St
Philadelphia, PA 19104-4238

Mailing address

8360 Old York Rd
Elkins Park, PA 19027-1598
Phone (215) 780-1400

Other practice location 1

420 S 5th Ave
West Reading, PA 19611-2143
Phone (484) 628-4879

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240116002310 PA Practitioner - Physician Assistant 8628420684 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tower Health Medical GroupGroup PAC ID 7618889213, 578 clinicians

Practice addresses (Care Compare)

2610 Keiser Blvd
Wyomissing, PA 19610-3333
Phone (484) 750-3950

301 S 7TH Ave
Radiology Tower Health Medical Group
West Reading, PA 19611-1442
Phone (484) 628-8112

420 S 5TH Ave
West Reading, PA 19611-2143

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA065259PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Tower Health Medical Group CurrentSince Jan 1, 2025 Accepting new patients
Tower Health Medical Group CurrentSince Jan 1, 2025 Accepting new patients
University of Penn-Medical Group CurrentSince Feb 5, 2024 Accepting new patients
University of Penn-Medical Group CurrentSince Feb 5, 2024 Accepting new patients

Locations

3400 Spruce St
Fl 2
Philadelphia, PA 19104
Phone (215) 662-2428

301 S 7th Ave
Ste 130
West Reading, PA 19611
Phone (610) 988-4630

420 S 5th Ave
West Reading, PA 19611
Phone (484) 628-3637

2610 Keiser Blvd
Wyomissing, PA 19610
Phone (484) 628-9127

Organizations & group practices 6

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 6

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": "1701388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733702400000",
    "number": "1497521330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8360 OLD YORK RD",
            "city": "ELKINS PARK",
            "state": "PA",
            "postal_code": "190271598",
            "telephone_number": "215-780-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044238",
            "telephone_number": "215-662-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "420 S 5th Ave",
            "address_purpose": "LOCATION",
            "city": "West Reading",
            "state": "PA",
            "postal_code": "196112143",
            "country_code": "US",
            "telephone_number": "484-628-4879",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "SHANNON",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-12-01",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA065259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.