Shannon Overholt

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

155780 Issued in FL

Practice address

2001 Kingsley Ave
Orange Park, FL 32073-5148

Phone

(904) 639-2000

Fax

(904) 639-2015

NPI assigned

Mar 28, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Emergency Medicine

Education

University of Mississippi School of Medicine, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Paragon Emergency Services LLCGroup PAC ID 8628153087, 401 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HCA Florida Orange Park Hospital Hospital, Orange Park, FL, CCN 100226

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Paragon Emergency Services LLC

  • Emergency Medicine Physician
  • Winter Haven, FL
  • NPI 1912101650
  Medicare reassignment Care Compare group NPD
• Emergency Medicine Services of FL, LLC

  • Emergency Medicine Physician
  • Aventura, FL
  • NPI 1043917180
  Medicare reassignment NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Orange Park Medical Center, Inc.

  • General Acute Care Hospital
  • Orange Park, FL
  • NPI 1689611501
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654214400000",
    "number": "1730717570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 KINGSLEY AVE",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320735148",
            "fax_number": "904-639-2015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 KINGSLEY AVE",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320735148",
            "telephone_number": "904-639-2000",
            "fax_number": "904-639-2015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OVERHOLT",
        "first_name": "SHANNON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-28",
        "last_updated": "2022-06-03",
        "certification_date": "2022-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "155780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cindy-Joy Ortiz, MS, EDS
• Diana Carolina Ortiz
• Amanda Lynn Osborne, PT
• Otolaryngology Surgical Associates
• David J Otto
• Eric James Overton, HAS
• Meera Rajshekar Oza, MD
• Misty Padgett
• Jayalakshmi Padmanabhan, M.D., P.A.
• Amy Page

• Emergency Medicine Physician in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Emergency Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 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.

Verify at the official NPI Registry.