NPIMap

Individual provider Active NPI

Shirley Lynn Hanley, DR.

  • Family Nurse Practitioner
  • Wilsonville, OR
National Provider Identifier
1730604166
Registry record updated Aug 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F06172350 Issued in OR
Practice address
25117 SW Parkway Ave Ste B
Wilsonville, OR 97070
Phone
(971) 224-2505
NPI assigned
Aug 7, 2017
Last updated
Aug 26, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X F06172350 OR
Family Nurse Practitioner 363LF0000X F06172350 OR Primary

Addresses

Primary practice location

25117 SW Parkway Ave Ste B
Wilsonville, OR 97070

Mailing address

25117 SW Parkway Ave Ste B
Wilsonville, OR 97070-9697

Other practice location 1

6751 Edison Rd
Marsing, ID 83639-8056
Phone (208) 969-0686

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20170927004691 OR Practitioner - Nurse Practitioner 0042584187 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Well Spring Health LLCGroup PAC ID 4385075902, 2 clinicians

Practice addresses (Care Compare)

835 Crater Lake Ave
Medford, OR 97504-6505
Phone (888) 719-3491

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
22.97 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
76.57

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F06172350ORMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Well Spring Health LLC CurrentSince Apr 1, 2020 Accepting new patients

Locations

1208 Beall Ln
Central Point, OR 97502

835 Crater Lake Ave
Medford, OR 97504
Phone (541) 507-4141

Organizations & group practices 1

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.

Hospital & facility affiliations 6

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": "1502064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535241600000",
    "number": "1730604166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25117 SW PARKWAY AVE STE B",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970709697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25117 SW PARKWAY AVE STE B",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "97070",
            "telephone_number": "971-224-2505"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6751 Edison Rd",
            "address_purpose": "LOCATION",
            "city": "Marsing",
            "state": "ID",
            "postal_code": "836398056",
            "country_code": "US",
            "telephone_number": "208-969-0686",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HANLEY",
        "first_name": "SHIRLEY",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "DR.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-07",
        "last_updated": "2018-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OR",
            "license": "F06172350",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "F06172350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilsonville, OR

Sources for this page

Verify at the official NPI Registry.