Shannon Henderson, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

202004735NP-PP Issued in OR

Practice address

520 Medical Center Dr Ste 201
Medford, OR 97504-4334

Phone

(541) 789-5711

Fax

(541) 789-5710

NPI assigned

Oct 4, 2012

Last updated

Jun 17, 2020By the provider in NPPES

Sex

Female

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 OR

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

Specialty

Nurse Practitioner

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

AsanteGroup PAC ID 0547177321, 141 clinicians

Asante Three Rivers Medical Center LLCGroup PAC ID 9931197993, 98 clinicians

Asante Physician PartnersGroup PAC ID 8325206246, 227 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Asante Rogue Regional Medical Center Hospital, Medford, OR, CCN 380018
• Asante Three Rivers Medical Center Hospital, Grants Pass, OR, CCN 380002

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Asante

  dba Asante Rogue Regional Medical Center

  • General Acute Care Hospital
  • Medford, OR
  • NPI 1770587107
  Medicare reassignment Care Compare group NPD
• Asante Physician Partners

  • Family Medicine Physician
  • Medford, OR
  • NPI 1922381326
  Medicare reassignment Care Compare group NPD
• Asante Three Rivers Medical Center, LLC

  • General Acute Care Hospital
  • Grants Pass, OR
  • NPI 1801891809
  Medicare reassignment Care Compare group NPD
• Asante

  dba Heimann Cancer Center

  • Specialty Pharmacy
  • Medford, OR
  • NPI 1699426684
  NPD
• Asante Ashland Community Hospital, LLC

  • General Acute Care Hospital
  • Ashland, OR
  • NPI 1730628827
  NPD

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

• Asante

  dba Asante Rogue Regional Medical Center

  • General Acute Care Hospital
  • Medford, OR
  • NPI 1770587107
  Care Compare affiliation
• Asante Three Rivers Medical Center, LLC

  • General Acute Care Hospital
  • Grants Pass, OR
  • NPI 1801891809
  Care Compare affiliation

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

{
    "created_epoch": "1349308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592352000000",
    "number": "1740532480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 748157",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900748157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 MEDICAL CENTER DR STE 201",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975044334",
            "telephone_number": "541-789-5711",
            "fax_number": "541-789-5710"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1001 Blythe Blvd",
            "address_2": "Ste 300 - Cardiac Surgery",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282035866",
            "country_code": "US",
            "telephone_number": "704-373-0212",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 Medical Park Dr",
            "address_2": "Ste 230",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "NC",
            "postal_code": "280252982",
            "country_code": "US",
            "telephone_number": "704-403-1349",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10650 Park Rd",
            "address_2": "Ste 220",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282108538",
            "country_code": "US",
            "telephone_number": "704-667-3840",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1001 Blythe Blvd",
            "address_2": "STE 300- Adult Cardiology",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282035866",
            "country_code": "US",
            "telephone_number": "704-373-0212",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "SHANNON",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-04",
        "last_updated": "2020-06-17",
        "certification_date": "2020-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5009257",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OR",
            "license": "202004735NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacob James Henderson
• Jennifer Henderson, DO
• Jennifer M Henderson, MS, LPC
• Kathryn Ann Henderson, D.O.
• Robyn M Henderson, L.M.T.
• Sara Kay Hendricksom, PHARM D
• Kristi Noel Hennan, M.D.
• Carolyn Ann Hennessey, M.A., LMFT
• Henry Harbert DMD LLC
• Evelyn L Henry, MD

• Nurse Practitioner in Medford, OR
• Providers in Medford, OR by specialty
• Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2020; 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.