Active NPI
Shannon Carlson
- Acute Care Nurse Practitioner
- Springfield, OR
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acute Care Nurse Practitioner
- License
- 201703390NP-PP
- Practice address
- 3311 Riverbend Dr
Springfield, OR 97477-8800 - Phone
- (541) 484-4332
- Fax
- (541) 302-0786
- NPI assigned
- Aug 18, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | ARNP 9380645 | FL | |
| Acute Care Nurse Practitioner | 363LA2100X | 201703390NP-PP | OR | Primary |
Addresses
Primary practice location
3311 Riverbend Dr
Springfield, OR 97477-8800
Mailing address
1115 SE 164TH Ave Dept 358
Vancouver, WA 98683-8004
Phone (360) 729-1459
Other practice location 1
38135 Market Sq
Zephyrhills, FL 33542-7505
Phone (352) 567-0188
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 013393500 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL, OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
3311 Riverbend Dr
Springfield, OR 97477-8800
Phone (541) 222-7218
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ARNP 9380645 | FL | MD | Acute Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Bend Medical Center Inc | Current | Accepting new patients | |
| Florida Medical Clinic, LLC | Current | Accepting new patients | |
| Florida Medical Clinic LLC | Current | Accepting new patients | |
| Peacehealth | Current | Accepting new patients | |
| Peacehealth Medical Group | Past | Accepting new patients |
Locations
38135 Market Square Dr
Zephyrhills, FL 33542
Phone (352) 567-0188
1900 Woodland Dr
Coos Bay, OR 97420
Phone (541) 267-5151
2801 NW Mercy Dr
Ste 350
Roseburg, OR 97471
Phone (541) 222-2700
3311 Riverbend Dr
Fl 3
Springfield, OR 97477
Phone (541) 222-5144
3311 Riverbend Dr
Springfield, OR 97477
Phone (541) 222-3531
1115 SE 164th Ave
Dept 358
Vancouver, WA 98683
Phone (360) 729-1253
Interoperability endpoints
- scarlson355374@direct.peacehealth.org
Organizations & group practices 5
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.
-
dba NBMC-Main
- Multi-Specialty Clinic/Center
- Coos Bay, OR
- NPI 1407812365
-
- Clinic/Center
- Zephyrhills, FL
- NPI 1821055690
-
dba Florida Medical Clinic Pharmacy
- Pharmacy
- Zephyrhills, FL
- NPI 1669548020
-
- Family Medicine Physician
- Eugene, OR
- NPI 1447207287
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Psychiatric Hospital Unit
- Eugene, OR
- NPI 1568236974
-
dba Cottage Grove Community Medical CT
- Critical Access Hospital
- Cottage Grove, OR
- NPI 1902892391
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1408320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1700285582",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1115 SE 164TH AVE DEPT 358",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986838004",
"telephone_number": "360-729-1459"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3311 RIVERBEND DR",
"city": "SPRINGFIELD",
"state": "OR",
"postal_code": "974778800",
"telephone_number": "541-484-4332",
"fax_number": "541-302-0786"
}
],
"practiceLocations": [
{
"address_1": "38135 Market Sq",
"address_purpose": "LOCATION",
"city": "Zephyrhills",
"state": "FL",
"postal_code": "335427505",
"country_code": "US",
"telephone_number": "352-567-0188",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CARLSON",
"first_name": "SHANNON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-08-18",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "FL",
"license": "ARNP 9380645",
"primary": false
},
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "OR",
"license": "201703390NP-PP",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "013393500",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Springfield, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.