Debra Anne Shannon, ARNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP61529272 Issued in WA

Practice address

1410 NE 106TH Ave
Portland, OR 97220-3934

Phone

(503) 460-0405

Fax

(503) 460-0434

NPI assigned

Apr 5, 2024

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

Medicare fee-for-service enrollment

Enrolled in OR

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, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bridge City Family Medical Clinic PCGroup PAC ID 7810988292, 7 clinicians

Practice addresses (Care Compare)

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.

• Bridge City Family Medical Clinic, PC

  • Multi-Specialty Clinic/Center
  • Portland, OR
  • NPI 1548330715
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1712275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712275200000",
    "number": "1598517088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1410 NE 106TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972203934",
            "telephone_number": "503-460-0405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 NE 106TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972203934",
            "telephone_number": "503-460-0405",
            "fax_number": "503-460-0434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "DEBRA",
        "middle_name": "ANNE",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-05",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP61529272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chloe M Shanley, MD
• Kelsea Shanley, RDN
• Amanda Jo Shannahan
• Shannon Anastasiadis Pmhnp-BC LLC
• Angela Shannon
• Evelyn Shannon, LMT
• Frederick Shannon
• Gabriel Shannon, LPC
• Jacqueline Riegelhaupt-Kamrin Shannon, LMFT
• Jeffery Shannon

• Family Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2024; 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.