Shannon Shi, M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

036111685 Issued in IL

Practice address

1335 N Mill St
Ste 100
Naperville, IL 60563-2261

Phone

(630) 646-8000

Fax

(630) 646-8007

NPI assigned

May 10, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • San Francisco, CA
  • NPI 1841373800
  NPD
• Edward Health Ventures

  • Family Medicine Physician
  • Naperville, IL
  • NPI 1154371185
  NPD (past)
• Edward Health Ventures

  • Psychiatry Physician
  • Plainfield, IL
  • NPI 1225108251
  NPD (past)
• Edward Health Ventures

  • Child & Adolescent Psychiatry Physician
  • Naperville, IL
  • NPI 1245281724
  NPD (past)
• Edward Health Ventures

  • Pediatrics Physician
  • Naperville, IL
  • NPI 1346291838
  NPD (past)
• Edward Health Ventures

  • Internal Medicine Physician
  • Naperville, IL
  • NPI 1467637264
  NPD (past)
• Edward Health Ventures

  • Psychiatry Physician
  • Naperville, IL
  • NPI 1568413995
  NPD (past)
• Edward Health Ventures

  • Psychiatry Physician
  • Naperville, IL
  • NPI 1992862114
  NPD (past)

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639612800000",
    "number": "1780633271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1335 N MILL ST",
            "address_2": "STE 100",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605632261",
            "telephone_number": "630-646-8000",
            "fax_number": "630-646-8007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1335 N MILL ST",
            "address_2": "STE 100",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605632261",
            "telephone_number": "630-646-8000",
            "fax_number": "630-646-8007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHI",
        "first_name": "SHANNON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-10",
        "last_updated": "2021-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "IL",
            "license": "036111685",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036111685 1",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "2220936",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1425 S Main St",
            "city": "Walnut Creek",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945965318",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Shahan Sherwani
• Deepa Sheth, DPT
• Rina Kamalesh Sheth, D.O.
• Sneha Sheth, PT
• Akshatha Shetty, M.D.
• Michelle Shields, LPC, CADC
• Michelle Lynn Shields, SLP
• Timothy Randall Shields, LCPC
• Yong Taek Shim, D.D.S.
• Rakhi Shingala

• Child & Adolescent Psychiatry Physician in Naperville, IL
• Providers in Naperville, IL by specialty
• Child & Adolescent Psychiatry Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.