Shanna Jay Dierker, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

15817 Issued in WI

Practice address

3925 N Gateway Dr
Appleton, WI 54913-7863

Phone

(920) 702-6371

NPI assigned

Jan 25, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL, MO, WI3 enrollments

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 3

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Blessing HospitalGroup PAC ID 3072422534, 414 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Blessing Hospital Hospital, Quincy, IL, CCN 140015

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shannadierker@blessing.allscriptsdirect.net
• Direct secure messaging: sdierker344006@direct.thedacare.org

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.

• Thedacare, Incorporated

  • Family Medicine Physician
  • New London, WI
  • NPI 1376656959
  Medicare reassignment Care Compare group NPD
• Blessing Hospital

  • Multi-Specialty Clinic/Center
  • Quincy, IL
  • NPI 1114471737
  Medicare reassignment Care Compare group
• Blessing Corporate Services, Inc

  • Rural Health Clinic/Center
  • Kahoka, MO
  • NPI 1245427608
  Medicare reassignment NPD
• Blessing Corporate Services Inc

  • Rural Health Clinic/Center
  • Palmyra, MO
  • NPI 1548368004

  Family

  NPD
• Blessing Hospital

  • General Acute Care Hospital
  • Quincy, IL
  • NPI 1760571699
  NPD
• Quincy Clinical Laboratory Services SC

  • Anatomic Pathology & Clinical Pathology Physician
  • Quincy, IL
  • NPI 1114773272
  NPD
• West Central Pathology Specialists, S.C.

  • Anatomic Pathology & Clinical Pathology Physician
  • Quincy, IL
  • NPI 1083895452
  NPD
• Thedacare Medical Center - Berlin, Inc.

  • Critical Access Hospital
  • Berlin, WI
  • NPI 1760413777
  NPD (past)

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

• Blessing Hospital

  • Nurse Practitioner
  • Quincy, IL
  • NPI 1417204827

  Hospital

  Care Compare affiliation
• Blessing Hospital

  • General Acute Care Hospital
  • Quincy, IL
  • NPI 1760571699
  Care Compare affiliation

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

{
    "created_epoch": "1453680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739923200000",
    "number": "1558728337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NEENAH CTR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549563070",
            "telephone_number": "920-702-6371",
            "fax_number": "920-358-1173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3925 N GATEWAY DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549137863",
            "telephone_number": "920-702-6371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIERKER",
        "first_name": "SHANNA",
        "middle_name": "JAY",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-25",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IA",
            "license": "A143402",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209-014331",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "15817",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "2015032867",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041404031",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Danielle M Diedrich, LCSW
• Erin Marie Diedrick, PA-C
• Klair Diedrick
• Rebecca Diener
• Tam M Diep, DO
• Brenda Jeanne Dierschke, MD
• Timothy C Dietzen
• Different Perspectives Counseling, LLC
• Dignity Counseling Collective LLC
• Jean E Dill, APNP

• Family Nurse Practitioner in Appleton, WI
• Providers in Appleton, WI by specialty
• Family Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2025; 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.