Individual provider Active NPI

Shannon Dale Armstrong, M.D.

  • Plastic and Reconstructive Surgery Physician
  • Grand Rapids, MI
National Provider Identifier
1780891176
Registry record updated Aug 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
4301088227 Issued in MI
Practice address
245 Cherry Street S.E.
Suite 302
Grand Rapids, MI 49503-4607
Phone
(616) 459-4131
Fax
(616) 459-6030
NPI assigned
May 17, 2007
Last updated
Aug 16, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 4301088227 MI
Plastic and Reconstructive Surgery Physician 2086S0122X 4301088227 MI Primary

Addresses

Primary practice location

245 Cherry Street S.E.
Suite 302
Grand Rapids, MI 49503-4607

Mailing address

245 Cherry Street
Suite 302
Grand Rapids, MI 49503-4607
Phone (616) 459-4131

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20120717000552 MI Practitioner - Hand SurgeryPractitioner - Plastic and Reconstructive Surgery 7517137649 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hand SurgeryAlso: Plastic and Reconstructive Surgery
Education
Wright State University Boonshoft School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hand and Plastic Surgery Centre PLCGroup PAC ID 0042272940, 4 clinicians

Practice addresses (Care Compare)

245 Cherry St SE
Suite 302
Grand Rapids, MI 49503-4607
Phone (616) 459-4131

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)16
Melanoma (skin cancer) excision1-10
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301088227MIMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hand & Plastic Surgery Centre PLC Plastic and Reconstructive Surgery CurrentSince Aug 1, 2012 Accepting new patients
Rehabilitation Medicine Associates,PLC PastSince Aug 1, 2012 Accepting new patients

Locations

245 Cherry St SE
Ste 302
Grand Rapids, MI 49503
Phone (616) 459-4131

Organizations & group practices 2

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1345075200000",
    "number": "1780891176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 CHERRY STREET",
            "address_2": "SUITE 302",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034607",
            "telephone_number": "616-459-4131",
            "fax_number": "616-459-6030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 CHERRY STREET S.E.",
            "address_2": "SUITE 302",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034607",
            "telephone_number": "616-459-4131",
            "fax_number": "616-459-6030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ARMSTRONG",
        "first_name": "SHANNON",
        "middle_name": "DALE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2012-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301088227",
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "MI",
            "license": "4301088227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.