Shannon Moeggenborg, APRN, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704265833 Issued in MI

Practice address

1105 Sixth St
Traverse City, MI 49684-2349

Phone

(231) 947-0673

Fax

(801) 740-2847

NPI assigned

Aug 14, 2014

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Interlochen Emergency Group PCGroup PAC ID 3577918606, 49 clinicians

Hawk Emergency Group, P.C.Group PAC ID 6800241050, 55 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Munson Medical Center Hospital, Traverse City, MI, CCN 230097

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Hawk Emergency Group, P.C.

  • Emergency Medicine Physician
  • Charlevoix, MI
  • NPI 1073295135
  Medicare reassignment Care Compare group NPD
• Interlochen Emergency Group, P.C.

  • Emergency Medicine Physician
  • Traverse City, MI
  • NPI 1336821495
  Medicare reassignment Care Compare group NPD
• Caberfae Emergency Group, P.C.

  • Emergency Medicine Physician
  • Cadillac, MI
  • NPI 1447932504
  Medicare reassignment NPD
• Northwestern Michigan Emergency Physicians PC

  • Emergency Medicine Physician
  • Traverse City, MI
  • NPI 1073597944
  Medicare reassignment NPD
• Traverse Observation Physician Services PC

  • Emergency Medicine Physician
  • Traverse City, MI
  • NPI 1851671697
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Munson Medical Center

  • General Acute Care Hospital
  • Traverse City, MI
  • NPI 1952307852
  Care Compare affiliation

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

{
    "created_epoch": "1407974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690329600000",
    "number": "1528467669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4624 N SPIDER LAKE RD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496968440",
            "telephone_number": "231-947-0673",
            "fax_number": "801-740-2847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 SIXTH ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842349",
            "telephone_number": "231-947-0673",
            "fax_number": "801-740-2847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOEGGENBORG",
        "first_name": "SHANNON",
        "credential": "APRN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-14",
        "last_updated": "2023-07-26",
        "certification_date": "2023-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704265833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0B86032",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• April Ann Missias
• Eileen Mist
• Elizabeth Ann Mitchell, RN, BSN
• Coda Mix
• Kylie Janae Mix, RDH
• Emad N Mohammed, DBS
• Jennifer Marie Mohler
• Erik Nelson Molby, DMD
• Monarch Bay Wellness, PLLC
• Monarch Home Health Services

• Family Nurse Practitioner in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.