Shannon L. Vitelli, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

OS011868 Issued in PA

Practice address

17 Iron Bridge Dr Ste 100
Collegeville, PA 19426-2042

Phone

(484) 622-6340

Fax

(484) 622-6357

NPI assigned

Jun 11, 2006

Last updated

Jun 30, 2021By the provider in NPPES

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 10

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Pediatric Medicine

Education

Philadelphia College of Osteopathic Medicine, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fornance Physician Services IncGroup PAC ID 8527962661, 105 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shannon.vitelli@direct.einstein.edu

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.

• Fornance Physician Services, Inc

  dba Family OB/GYN Center

  • Obstetrics & Gynecology Physician
  • Norristown, PA
  • NPI 1053363523
  Medicare reassignment Care Compare group NPD
• Einstein Community Health Associates, Inc

  • Family Medicine Physician
  • Phila, PA
  • NPI 1558316109
  Medicare reassignment NPD
• Einstein Community Health Associates, Inc

  • Internal Medicine Physician
  • Philadelphia, PA
  • NPI 1427662931
  NPD
• Fornance Physician Services, Inc

  dba Einstein Physicians Collegeville

  • Internal Medicine Physician
  • Collegeville, PA
  • NPI 1023439825
  NPD
• Fornance Physician Services, Inc.

  • Neurological Surgery Physician
  • Plymouth Meeting, PA
  • NPI 1699459388
  NPD

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625011200000",
    "number": "1568404143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 IRON BRIDGE DR",
            "address_2": "STE 100",
            "city": "COLLEGEVILLE",
            "state": "PA",
            "postal_code": "194262042",
            "telephone_number": "610-489-5782",
            "fax_number": "610-489-6418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 IRON BRIDGE DR STE 100",
            "city": "COLLEGEVILLE",
            "state": "PA",
            "postal_code": "194262042",
            "telephone_number": "484-622-6340",
            "fax_number": "484-622-6357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VITELLI",
        "first_name": "SHANNON",
        "middle_name": "L.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-11",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "OS011868",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "7402478",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IBC - PC/KHPE",
            "identifier": "2209467000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE MERCY",
            "identifier": "30010139",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "36156-OS011868",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA HMO/PPO",
            "identifier": "9514702",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICHOICE/INTERCOUNTY",
            "identifier": "2209467000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "3373024",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OMAP",
            "identifier": "0019807030001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH ID#",
            "identifier": "11212082",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "1523072",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tayler Ann Venezia
• Adeline M Verticelli, M.D.
• Albina Veys, DMD
• Laurel Vincent
• Lisa Richards Vitelli, OTRL
• Tamara Volkova, DMD
• Bharvi Vyas, PHARMD.
• Michelle Wagenhoffer, MA, LBS
• Surbhi Wagle
• Craig E Wagner Jr., M.ED.

• Pediatrics Physician in Collegeville, PA
• Providers in Collegeville, PA by specialty
• Pediatrics Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2021; 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.