NPIMap

Individual provider Active NPI

Shannan Theresa O'Brien, PA-C

  • Surgical Physician Assistant
  • Mount Vernon, WA
National Provider Identifier
1700326824
Registry record updated Aug 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA60740417 Issued in WA
Practice address
2320 Freeway Dr
Mount Vernon, WA 98273-5445
Phone
(360) 814-6880
Fax
(360) 814-6953
NPI assigned
Mar 8, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA60740417 WA Primary

Addresses

Primary practice location

2320 Freeway Dr
Mount Vernon, WA 98273-5445

Mailing address

1400 E Kincaid St
Mount Vernon, WA 98274-4127

Other names 1

  • Shannan Theresa Roy Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sobrien35999@skagit.direct-ci.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170509002364 WA Practitioner - Physician Assistant 3971880592 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Public Hospital Dist No 1 SkagitGroup PAC ID 6800793522, 321 clinicians

Practice addresses (Care Compare)

1400 E Kincaid St
Mount Vernon, WA 98274-4127
Phone (360) 428-2500

1415 E Kincaid St
Mount Vernon, WA 98274-4126
Phone (360) 416-5750

211 S 13TH St
Mount Vernon, WA 98274-4107
Phone (360) 814-5900

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Proliance Surgeons, Inc., P.S. CurrentSince May 1, 2017 Accepting new patients
Proliance Surgeons Inc P S Surgical CurrentSince May 1, 2017 Accepting new patients
Public Hospital Dist No 1 Skagit CurrentSince Jul 19, 2021 Accepting new patients
Public Hospital District No 1 Skagit CurrentSince Jul 19, 2021 Accepting new patients
Public Hospital Dist No 1 Skagit Past Accepting new patients

Locations

2320 Freeway Dr
Mount Vernon, WA 98273
Phone (360) 814-6800

1401 S Laventure Rd
Mount Vernon, WA 98274
Phone (360) 424-2400

1400 E Kincaid St
Mount Vernon, WA 98274
Phone (360) 428-2586

805 Madison St
Ste 901
Seattle, WA 98104
Phone (206) 264-8100

Interoperability endpoints

  • Direct secure messaging: shannan.obrien.p15@direct.proliance.nextgenshare.com

Organizations & group practices 7

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 2

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": "1488931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627948800000",
    "number": "1700326824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 E KINCAID ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2320 FREEWAY DR",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982735445",
            "telephone_number": "360-814-6880",
            "fax_number": "360-814-6953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BRIEN",
        "first_name": "SHANNAN",
        "middle_name": "THERESA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-08",
        "last_updated": "2021-08-03",
        "certification_date": "2021-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA60740417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sobrien35999@skagit.direct-ci.com",
            "affiliation": "N",
            "endpointDescription": "Provider Direct address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2320 Freeway Dr",
            "city": "Mount Vernon",
            "state": "WA",
            "country_code": "US",
            "postal_code": "982735445",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SHANNAN",
            "last_name": "ROY",
            "middle_name": "THERESA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mount Vernon, WA

Sources for this page

Verify at the official NPI Registry.