Shane T Mallon, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

22748 Issued in ND

Practice address

1500 E Medical Center Dr
Ann Arbor, MI 48109-5000

Phone

(734) 936-4000

NPI assigned

Apr 2, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MI, FL, TX, ND, AL5 enrollments

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 5

Specialty

Diagnostic RadiologyAlso: Interventional Radiology

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sanford ClinicGroup PAC ID 4385882976, 57 clinicians

Concord Radiology PLLCGroup PAC ID 8628332061, 217 clinicians

Sanford ClinicGroup PAC ID 0244143824, 268 clinicians

Regents of the University of MichiganGroup PAC ID 3779496856, 3,344 clinicians

ER Physician Group at Jackson HospitalGroup PAC ID 8729059472, 153 clinicians

Peterson Medical AssociatesGroup PAC ID 1355467887, 192 clinicians

Metropolitan HospitalGroup PAC ID 5597651836, 421 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension St John Medical Center Hospital, Tulsa, OK, CCN 370114
• Ascension Saint Thomas Hospital Hospital, Nashville, TN, CCN 440082
• North Texas Medical Center Hospital, Gainesville, TX, CCN 450090
• Sanford Medical Center Fargo Hospital, Fargo, ND, CCN 350011
• St Joseph'S Hospital Hospital, Tucson, AZ, CCN 030011

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/10998/brand/1/csg/1/fhir/r4

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.

• Metropolitan Hospital

  • Internal Medicine Physician
  • Wyoming, MI
  • NPI 1811937519
  Medicare reassignment Care Compare group NPD
• Regents of the University of Michigan

  • Internal Medicine Physician
  • Ann Arbor, MI
  • NPI 1205868353
  Medicare reassignment Care Compare group NPD
• Concord Radiology PLLC

  • Diagnostic Radiology Physician
  • Lubbock, TX
  • NPI 1598260515

  MI

  Medicare reassignment Care Compare group NPD
• ER Physician Group at Jackson Hospital

  • General Practice Physician
  • Marianna, FL
  • NPI 1407801194
  Medicare reassignment Care Compare group NPD
• Peterson Medical Associates

  • Obstetrics & Gynecology Physician
  • Kerrville, TX
  • NPI 1770800575
  Medicare reassignment Care Compare group NPD
• Sanford Clinic

  • Diagnostic Radiology Physician
  • Fargo, ND
  • NPI 1306641345

  MI

  Medicare reassignment Care Compare group NPD
• Coaxion PLLC

  • Diagnostic Radiology Physician
  • Lubbock, TX
  • NPI 1629805221

  MI

  Medicare reassignment NPD
• Prime Healthcare Services-Gadsden Physician Management LLC

  • Family Medicine Physician
  • Gadsden, AL
  • NPI 1356731467
  Medicare reassignment NPD
• Sanford Medical Center Fargo

  • Family Medicine Physician
  • West Fargo, ND
  • NPI 1184917924
  Medicare reassignment NPD
• Regents of the University of Michigan

  • Diagnostic Radiology Physician
  • Ann Arbor, MI
  • NPI 1871528026
  NPD
• Regents of the University of Michigan

  • Specialty Pharmacy
  • Dexter, MI
  • NPI 1952181919
  NPD
• Sanford Medical Center Fargo

  • Rural Health Clinic/Center
  • Lamoure, ND
  • NPI 1164439196
  NPD

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

• Gainesville Community Hospital, Inc.

  • General Acute Care Hospital
  • Gainesville, TX
  • NPI 1972071991
  Care Compare affiliation
• Saint Thomas West Hospital

  • General Acute Care Hospital
  • Nashville, TN
  • NPI 1629025648
  Care Compare affiliation
• Sanford Health of Northern Minnesota

  • Ambulatory Surgical Clinic/Center
  • Bemidji, MN
  • NPI 1093876922

  Hospital

  Care Compare affiliation
• Sanford Medical Center Fargo

  • Family Medicine Physician
  • West Fargo, ND
  • NPI 1184917924

  Hospital

  Care Compare affiliation
• Sanford Medical Center Fargo

  • General Acute Care Hospital
  • Fargo, ND
  • NPI 1245519081
  Care Compare affiliation
• Sanford Medical Center Fargo

  • General Acute Care Hospital
  • Fargo, ND
  • NPI 1528009412
  Care Compare affiliation
• Sanford Medical Center Fargo

  • Air Ambulance
  • Fargo, ND
  • NPI 1942415468

  Hospital

  Care Compare affiliation
• SMSJ Tucson Holdings LLC

  • General Acute Care Hospital
  • Tucson, AZ
  • NPI 1538535158
  Care Compare affiliation
• St John Medical Center Inc

  • General Acute Care Hospital
  • Tulsa, OK
  • NPI 1154417368
  Care Compare affiliation
• St John Medical Center Inc

  • Rehabilitation Hospital Unit
  • Tulsa, OK
  • NPI 1578656161
  Care Compare affiliation

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

{
    "created_epoch": "1396396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764547200000",
    "number": "1750709119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481081633",
            "telephone_number": "734-647-5299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E MEDICAL CENTER DR",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481095000",
            "telephone_number": "734-936-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4250 Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Marianna",
            "state": "FL",
            "postal_code": "324461917",
            "country_code": "US",
            "telephone_number": "850-526-2200",
            "fax_number": "850-718-2531",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALLON",
        "first_name": "SHANE",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-02",
        "last_updated": "2025-12-01",
        "certification_date": "2025-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "ME175471",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "ND",
            "license": "22748",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "4301105443",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Malika A Malik, DDS
• Herbert L Malinoff, MD
• Sophia Alice Mallery, CGC
• Kaitlin Malley, MD
• Ajitha Mallidi, MD
• Michelle Alyssa Mallory, AGACNP-BC
• Kelly Michele Malloy, MD
• Toni Malone, LLBSW
• Emily Maloney, BS
• Valerie Roedenbeck Maloof, LLMSW

• Diagnostic Radiology Physician in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Diagnostic Radiology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2025; 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.