Individual provider Active NPI

Shannon Marie Place, FNP-C

  • Family Nurse Practitioner
  • Nottingham, MD
National Provider Identifier
1659097236
Registry record updated Oct 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R194603 Issued in MD
Practice address
9619 Dundawan Rd
Nottingham, MD 21236-1011
Phone
(410) 206-8435
NPI assigned
Oct 17, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R194603 MD Primary

Addresses

Primary practice location

9619 Dundawan Rd
Nottingham, MD 21236-1011

Mailing address

9619 Dundawan Rd
Nottingham, MD 21236-1011

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20231023003612 DC Practitioner - Nurse Practitioner 7315393642 Reassigns benefits to 1 organization
I20231025003906 MD Practitioner - Nurse Practitioner 7315393642 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medstar Urgent Care LLCGroup PAC ID 9335303155, 300 clinicians

Practice addresses (Care Compare)

12 Medstar Blvd
Bel Air, MD 21015-1798
Phone (410) 877-8087

3064 Waldorf Market PL
Waldorf, MD 20603-4871
Phone (301) 932-5960

6317 York Rd
Baltimore, MD 21212-2310
Phone (443) 777-6890

6500 Baltimore National Pike
Catonsville, MD 21228-4200
Phone (410) 807-8067

7698 Dorchester Blvd
Hanover, MD 21076-1946
Phone (443) 755-9253

7825 York Rd
Towson, MD 21204-7445
Phone (443) 332-4353

8605 Ridgelys Choice Dr
Nottingham, MD 21236-2953
Phone (410) 248-2310

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R194603MDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Medstar Urgent Care, LLC Current Accepting new patients
Medstar Urgent Care LLC CurrentSince Oct 8, 2023 Accepting new patients
Medstar Urgent Care LLC Current Accepting new patients
Medstar Urgent Care LLC CurrentSince Oct 8, 2023 Accepting new patients

Locations

3007 Tilden St NW
Ste 5N
Washington, DC 20008

6317 York Rd
Baltimore, MD 21212
Phone (443) 777-6890

3064 Waldorf Market Pl
Waldorf, MD 20603
Phone (301) 932-5960

11915 Georgia Ave
Wheaton, MD 20902
Phone (301) 942-4505

Organizations & group practices 4

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": "1665964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665964800000",
    "number": "1659097236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9619 DUNDAWAN RD",
            "city": "NOTTINGHAM",
            "state": "MD",
            "postal_code": "212361011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9619 DUNDAWAN RD",
            "city": "NOTTINGHAM",
            "state": "MD",
            "postal_code": "212361011",
            "telephone_number": "410-206-8435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PLACE",
        "first_name": "SHANNON",
        "middle_name": "MARIE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-17",
        "last_updated": "2022-10-17",
        "certification_date": "2022-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R194603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nottingham, MD

Sources for this page

Verify at the official NPI Registry.