Individual provider Active NPI

Shannon Haas

  • Massage Therapist
  • Bend, OR
National Provider Identifier
1548857014
Registry record updated Dec 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
25952 Issued in OR
Practice address
55 NW Wall St Ste 100
Bend, OR 97703-3200
Phone
(541) 389-4321
Fax
(541) 389-4420
NPI assigned
Dec 30, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X 25952 OR Primary

Addresses

Primary practice location

55 NW Wall St Ste 100
Bend, OR 97703-3200

Mailing address

55 NW Wall St Ste 100
Bend, OR 97703-3200
Phone (541) 389-4321

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
25952ORMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Falling Waters LLC CurrentSince Jan 3, 2021 Accepting new patients

Locations

55 NW Wall St
Ste 100
Bend, OR 97703
Phone (541) 389-4321

Organizations & group practices 1

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": "1609286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609286400000",
    "number": "1548857014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 NW WALL ST STE 100",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977033200",
            "telephone_number": "541-389-4321",
            "fax_number": "541-389-4420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 NW WALL ST STE 100",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977033200",
            "telephone_number": "541-389-4321",
            "fax_number": "541-389-4420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAAS",
        "first_name": "SHANNON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-30",
        "last_updated": "2020-12-30",
        "certification_date": "2020-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": "25952",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.