Shannon Michele Gavin, MSN, RN, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2010007825 Issued in IN

Practice address

407 W Indiana Ave
Chesterton, IN 46304-2350

Phone

(219) 763-8112

Fax

(219) 764-5384

NPI assigned

Dec 9, 2010

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

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: shannon.gavin.p1@direct.northshorehealth.nextgenshare.com

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.

• Elite Internal Medicine PC

  • Internal Medicine Physician
  • Crown Point, IN
  • NPI 1528228301
  NPD (past)
• Mirich Medical Corporation

  • Cardiovascular Disease Physician
  • Merrillville, IN
  • NPI 1013982420
  NPD (past)

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

{
    "created_epoch": "1291852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464220800000",
    "number": "1801199070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1430",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463689230",
            "telephone_number": "219-764-3251",
            "fax_number": "219-764-3251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 W INDIANA AVE",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463042350",
            "telephone_number": "219-763-8112",
            "fax_number": "219-764-5384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAVIN",
        "first_name": "SHANNON",
        "middle_name": "MICHELE",
        "credential": "MSN, RN, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-09",
        "last_updated": "2016-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "2010007825",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201015570",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "71003579A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jill Gardner, PHD
• Hannah Garner, OTR
• Rylee Garza-Valtierra, RBT
• Virgil Gassoway
• Eric Gatewood, PTA
• Katherine Geise, OTR
• Beth Ann Gemeinhart, RPH
• Jill Gholson-Hearns, PTA, PES
• Easa Ghoreishi, MD
• Kassandra Glenn, RBT

• Family Nurse Practitioner in Chesterton, IN
• Providers in Chesterton, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2016; 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.