Shannon Whitney Clark, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4606 Issued in OK

Practice address

600 S Monroe St
Enid, OK 73701-7211

Phone

(580) 233-2300

NPI assigned

Jul 14, 2021

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

Medicare fee-for-service enrollment

Enrolled in OK

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, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oliver Street 5.01(a) IncGroup PAC ID 0042464125, 169 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Mary's Regional Medical Center Hospital, Enid, OK, CCN 370026

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as individual

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: shclark@conger.emadirect.md
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/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.

• Oliver Street 5.01(a) Inc.

  dba U.S. Dermatology Partners

  • Dermatology Physician
  • Dallas, TX
  • NPI 1457695413

  OK

  Medicare reassignment Care Compare group
• Emergency Services of Oklahoma PC

  • Emergency Medicine Physician
  • Norman, OK
  • NPI 1215249891
  Medicare reassignment
• Dermatology Associates

  • Dermatology Physician
  • Houston, TX
  • NPI 1356523039
  NPD (past)

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

• Uhs of Oklahoma, LLC

  dba St. Mary's Regional Medical Center

  • General Acute Care Hospital
  • Enid, OK
  • NPI 1417947466
  Care Compare affiliation

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

{
    "created_epoch": "1626220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632960000000",
    "number": "1811569270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5833 HUERFANO DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809233436",
            "telephone_number": "316-573-3088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 S MONROE ST",
            "city": "ENID",
            "state": "OK",
            "postal_code": "737017211",
            "telephone_number": "580-233-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SHANNON",
        "middle_name": "WHITNEY",
        "name_prefix": "Mrs.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-14",
        "last_updated": "2021-09-30",
        "certification_date": "2021-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "4606",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "4606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Elaine Christopher, MCP, LPC CANDIDATE
• Natalie Anne Ciavolino, PA-C
• Rebecca L Claborn
• Clare Savage PLLC
• James Clark, MCP, BHRS
• Kristin Ann Claypole, BSW, BHRS
• Mackenzy Cleveland
• Sarah Miller Coats, PH.D.
• Casey L Cochran, DO
• Becky Coffey

• Physician Assistant in Enid, OK
• Providers in Enid, OK by specialty
• Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 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.