Individual provider Active NPI

Shannon Kathleen Iakiri, N.P.

  • Family Nurse Practitioner
  • Grand Rapids, MI
National Provider Identifier
1821021098
Registry record updated Mar 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704211783 Issued in MI
Practice address
250 Cherry St SE Ste 2200
Grand Rapids, MI 49503-4608
Phone
(616) 685-5600
Fax
(616) 685-6745
NPI assigned
Jul 9, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704211783 MI Primary

Addresses

Primary practice location

250 Cherry St SE Ste 2200
Grand Rapids, MI 49503-4608

Mailing address

5800 Foremost Dr SE Ste 300
Grand Rapids, MI 49546-7062
Phone (616) 954-9800

Other names 1

  • Shannon Kathleen Taylor Former name

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061130000065 MI Practitioner - Nurse Practitioner 5496753477 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cancer and Hematology Centers of Western Mi, P.C.Group PAC ID 4082526793, 109 clinicians

Practice addresses (Care Compare)

18223 E 10 Mile Rd
Suite 100
Roseville, MI 48066-5821
Phone (586) 778-5880

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
96
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704211783MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cancer & Hematology Centers of Western Mi, P.C. CurrentSince Jan 1, 2006 Accepting new patients
Spectrum Health Hospitals Past Accepting new patients

Locations

15100 220th Ave
Big Rapids, MI 49307
Phone (231) 515-9410

6255 Inkster Rd
Ste 307
Garden City, MI 48135
Phone (248) 556-5582

710 Kenmoor Ave SE
Ste 200
Grand Rapids, MI 49546
Phone (616) 588-7246

145 Michigan St NE
Ste 3100
Grand Rapids, MI 49503
Phone (616) 954-9800

250 Cherry St SE
Ste 2200
Grand Rapids, MI 49503
Phone (616) 685-5600

5800 Foremost Dr SE
Ste 300
Grand Rapids, MI 49546
Phone (616) 389-1725

12460 Riley St
Holland, MI 49424
Phone (616) 399-1308

6425 Harvey St
Norton Shores, MI 49444
Phone (231) 737-3469

18223 E 10 Mile Rd
Ste 100
Roseville, MI 48066
Phone (586) 778-5880

Interoperability endpoints

  • Direct secure messaging: siakiri36404@direct.trinity-health.org
  • Direct secure messaging: siakiri103524@direct.covenanthealthcare.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584057600000",
    "number": "1821021098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5800 FOREMOST DR SE STE 300",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495467062",
            "telephone_number": "616-954-9800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 CHERRY ST SE STE 2200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034608",
            "telephone_number": "616-685-5600",
            "fax_number": "616-685-6745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IAKIRI",
        "first_name": "SHANNON",
        "middle_name": "KATHLEEN",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-09",
        "last_updated": "2020-03-13",
        "certification_date": "2020-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704211783",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "TAYLOR",
            "middle_name": "KATHLEEN",
            "credential": "N.P.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.