Individual provider Active NPI

Patricia Ann Shannon, PA-C

  • Physician Assistant
  • Hagerstown, MD
National Provider Identifier
1538724265
Registry record updated Apr 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C07394 Issued in MD
Practice address
11110 Medical Campus Rd Ste 205
Hagerstown, MD 21742-6797
Phone
(301) 665-4950
Fax
(301) 665-4956
NPI assigned
May 8, 2019
Last updated
Apr 27, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2023

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 C07394 MD Primary

Addresses

Primary practice location

11110 Medical Campus Rd Ste 205
Hagerstown, MD 21742-6797

Mailing address

6355 Walker LN Ste 507
Alexandria, VA 22310-3251
Phone (703) 738-4332

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20220104000892 MD Practitioner - Physician Assistant 4981039617 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Meritus Medical Center IncGroup PAC ID 7113811795, shared by 8 NPIs, 730 clinicians

Practice addresses (Care Compare)

11110 Medical Campus Rd
Hagerstown, MD 21742-6700

11110 Medical Campus Rd
Hagerstown, MD 21742-6797

11116 Medical Campus Rd
Hagerstown, MD 21742-6710
Phone (301) 790-8300

3 Byrkit Dr
Williamsport, MD 21795-1158
Phone (301) 582-1150

400 W 7TH St
Frederick, MD 21701-4506
Phone (240) 566-3300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2402WVMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Practices of Antietam LLC CurrentSince Jan 1, 2022 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

187 Thomas Johnson Dr
Ste 1
Frederick, MD 21702
Phone (301) 378-9421

11110 Medical Campus Rd
Ste 205
Hagerstown, MD 21742
Phone (301) 302-0503

11116 Medical Campus Rd
Hagerstown, MD 21742
Phone (301) 766-7600

3 Byrkit Dr
Williamsport, MD 21795
Phone (301) 582-1150

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1557273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682553600000",
    "number": "1538724265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6355 WALKER LN STE 507",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223103251",
            "telephone_number": "703-738-4332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11110 MEDICAL CAMPUS RD STE 205",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426797",
            "telephone_number": "301-665-4950",
            "fax_number": "301-665-4956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "PATRICIA",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-08",
        "last_updated": "2023-04-27",
        "certification_date": "2023-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C07394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

Verify at the official NPI Registry.