Shannon Lee Johnson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

002328 Issued in IA

Practice address

1228 E Rusholme St
Mob 1, Suite 3020
Davenport, IA 52803

Phone

(563) 421-7540

Fax

(563) 421-7549

NPI assigned

Jan 9, 2008

Last updated

Oct 12, 2021By 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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IA

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

Physician Assistant

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Genesis Health SystemGroup PAC ID 6103829338, 262 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Genesis Medical Center-Davenport Hospital, Davenport, IA, CCN 160033

Merit-based Incentive Payment System (MIPS)

Final score

34.85 of 100Reported as group

Quality

21.4

Improvement activities

0

Cost

76.92

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shannon.johnson@direct.genesishealth.com

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.

• Genesis Health System

  • Surgery Physician
  • Davenport, IA
  • NPI 1528616901
  Medicare reassignment Care Compare group NPD
• Ora Orthopedics, PC

  • Orthopaedic Surgery Physician
  • Durant, IA
  • NPI 1639159700
  NPD (past)
• Genesis Health System

  dba Genesis Health Group

  • Family Medicine Physician
  • Moline, IL
  • NPI 1164538435
  NPD (past)

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

• Genesis Health System

  dba Genesis Medical Center Davenport

  • General Acute Care Hospital
  • Davenport, IA
  • NPI 1972542264
  Care Compare affiliation

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

{
    "created_epoch": "1199836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633996800000",
    "number": "1750566790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1228 E RUSHOLME ST",
            "address_2": "MOB 1, SUITE 3020",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "52803",
            "telephone_number": "563-421-7540",
            "fax_number": "563-421-7549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1228 E RUSHOLME ST",
            "address_2": "MOB 1, SUITE 3020",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "52803",
            "telephone_number": "563-421-7540",
            "fax_number": "563-421-7549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SHANNON",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-09",
        "last_updated": "2021-10-12",
        "certification_date": "2021-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085003168",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "002328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "shannon.johnson@direct.genesishealth.com",
            "affiliation": "N",
            "endpointDescription": "Genesis Health System Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "1228 East Rusholme St",
            "address_2": "MOB 1, Suite 3020",
            "city": "Davenport",
            "state": "IA",
            "country_code": "US",
            "postal_code": "52803",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Matthew A Johnson, T-LMHC
• Monica Yvonne Johnson, LMSW
• Mya Johnson
• Randall Richard Johnson, OD
• Ronda Lee Johnson, ARNP
• Teresa Johnson, LMT
• Toshia Johnson, MSED, LMHC
• Trudi H Johnson, APRN, CNP
• Tyler Johnson, D.C.
• Jessica Johnstone, D.C.

• Physician Assistant in Davenport, IA
• Providers in Davenport, IA by specialty
• Physician Assistant in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2021; 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.