Individual provider Active NPI

Shannon G Shipman, PA-C

  • Surgical Physician Assistant
  • Skokie, IL
National Provider Identifier
1619788650
Registry record updated Mar 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
085010820 Issued in IL
Practice address
9669 Kenton Ave Ste 206
Skokie, IL 60076-1226
Phone
(847) 504-3300
NPI assigned
Jan 17, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085010820 IL
Surgical Physician Assistant 363AS0400X 085010820 IL Primary

Addresses

Primary practice location

9669 Kenton Ave Ste 206
Skokie, IL 60076-1226

Mailing address

2650 Ridge Ave Ste 1223
Evanston, IL 60201-1700

Other practice location 1

5741 W Cermak Rd
Cicero, IL 60804-2129
Phone (708) 222-0100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20250306001532 IL Practitioner - Physician Assistant 9032630017 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cermak Medical Group LLCGroup PAC ID 7113269242, 21 clinicians

Practice addresses (Care Compare)

2380 S Elmhurst Rd
Mt Prospect, IL 60056-5805
Phone (708) 222-0100

5741 W Cermak Rd
Cicero, IL 60804-2129
Phone (708) 222-0100

Hospital & facility affiliations

  • Northshore University Healthsystem - Evanston Hospital Hospital, Evanston, IL, CCN 140010

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085010820ILMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group Current Accepting new patients
Endeavor Health Medical Group CurrentSince Oct 6, 2025 Accepting new patients

Locations

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

9669 Kenton Ave
Ste 206
Skokie, IL 60076
Phone (847) 504-3300

Organizations & group practices 3

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.

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": "1737072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774483200000",
    "number": "1619788650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE STE 1223",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9669 KENTON AVE STE 206",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600761226",
            "telephone_number": "847-504-3300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5741 W Cermak Rd",
            "address_purpose": "LOCATION",
            "city": "Cicero",
            "state": "IL",
            "postal_code": "608042129",
            "country_code": "US",
            "telephone_number": "708-222-0100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIPMAN",
        "first_name": "SHANNON",
        "middle_name": "G",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-17",
        "last_updated": "2026-03-26",
        "certification_date": "2026-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085010820",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "085010820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Skokie, IL

Sources for this page

Verify at the official NPI Registry.