Individual provider Active NPI

Shannon Brady-Powers, N.P.

  • Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1669665303
Registry record updated Feb 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
SP009125 Issued in PA
Practice address
925 Chestnut St
Sixth Floor
Philadelphia, PA 19107-4216
Phone
(215) 955-6760
Fax
(215) 923-4532
NPI assigned
Aug 27, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otorhinolaryngology & Head-Neck Registered Nurse 163WX0601X RN536907 PA
Nurse Practitioner 363L00000X SP009125 PA Primary

Addresses

Primary practice location

925 Chestnut St
Sixth Floor
Philadelphia, PA 19107-4216

Mailing address

925 Chestnut St
6TH Floor
Philadelphia, PA 19107-4216
Phone (215) 955-6760

Other identifiers 1

IdentifierTypeStateIssuer
102879964MedicaidPA

Other names 1

  • Shannon Brady Former name

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090831000224 PA Practitioner - Nurse Practitioner 7214082080 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

925 Chestnut St
FL 6
Philadelphia, PA 19107-4204
Phone (215) 955-6760

Hospital & facility affiliations

  • Thomas Jefferson University Hospital Hospital, Philadelphia, PA, CCN 390174

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN536907PAMDOtorhinolaryngology & Head-Neck Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians CurrentSince Jul 19, 2009 Accepting new patients
Jefferson University Physicians Past Accepting new patients

Locations

1101 Chestnut St
Fl 16
Philadelphia, PA 19107
Phone (215) 955-6760

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

Organizations & group practices 2

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": "1188172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519171200000",
    "number": "1669665303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 CHESTNUT ST",
            "address_2": "6TH FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074216",
            "telephone_number": "215-955-6760",
            "fax_number": "215-923-4532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 CHESTNUT ST",
            "address_2": "SIXTH FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074216",
            "telephone_number": "215-955-6760",
            "fax_number": "215-923-4532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADY-POWERS",
        "first_name": "SHANNON",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-27",
        "last_updated": "2018-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WX0601X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Otorhinolaryngology & Head-Neck",
            "state": "PA",
            "license": "RN536907",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP009125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102879964",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "BRADY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.