Individual provider Active NPI

Shannon D Dale Hall, CRNA

  • Certified Registered Nurse Anesthetist
  • New Haven, CT
National Provider Identifier
1821098930
Registry record updated Dec 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
20635 Issued in SC
Practice address
500 College St
Yale New Haven Hospital
New Haven, CT 06511-8962
Phone
(203) 432-2700
NPI assigned
Jul 29, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 071173 TN
Certified Registered Nurse Anesthetist 367500000X 003790 CT
Certified Registered Nurse Anesthetist 367500000X 20635 SC Primary

Addresses

Primary practice location

500 College St
Yale New Haven Hospital
New Haven, CT 06511-8962

Mailing address

640 Urlacher Dr
Murfreesboro, TN 37129-8998
Phone (615) 796-0057

Other practice location 1

1330 Taylor St
Columbia, SC 29201-2915
Phone (803) 296-5010

Other identifiers 4

IdentifierTypeStateIssuer
PENDINGMedicaidSC
74007634MedicaidKY
3634996MedicaidTN
4072296OtherTNBCBS NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20031217000414 TN Practitioner - Certified Registered Nurse Anesthetist (Crna) 3870490907 Reassigns benefits to 2 organizations
I20170206001726 SC Practitioner - Certified Registered Nurse Anesthetist (Crna) 3870490907 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Paragon Anesthesia PCGroup PAC ID 8921044744, 214 clinicians

Practice addresses (Care Compare)

1 Medical Park Blvd
Bristol, TN 37620-7430
Phone (423) 390-0451

Hospital & facility affiliations

  • Wellmont Holston Valley Medical Center Hospital, Kingsport, TN, CCN 440017
  • Wellmont Bristol Regional Medical Center Hospital, Bristol, TN, CCN 440012

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
10941TNMDPhysical Therapist
10961TNMDPediatric Physical Therapist
20635SCMDCertified Registered Nurse Anesthetist
071173TNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
East Tennessee Ambulatory Surgery Center LLC CurrentSince Dec 9, 2024 Accepting new patients
Paragon Anesthesia PC Nurse Anesthetist, Certified Registered CurrentSince Dec 9, 2024 Accepting new patients
Prisma Health-Upstate CurrentSince Aug 23, 2017 Accepting new patients
Prisma Health-Upstate Current Accepting new patients
American Anesthesiology of Tennessee, P.C. CurrentSince Aug 1, 2019 Accepting new patients
Greenville Health System CurrentSince Jan 3, 2017 Accepting new patients
Pathology Associates of Greenville PA Current Accepting new patients
Prisma Health-Midlands Nurse Anesthetist, Certified Registered CurrentSince Jan 10, 2022 Accepting new patients
Prisma Health-Midlands Current Accepting new patients
Greenville Health System Current Accepting new patients
Prisma Health-Upstate CurrentSince Aug 23, 2017 Accepting new patients
Prisma Health-Midlands CurrentSince Jan 10, 2022 Accepting new patients
Singing River Health System Past Accepting new patients
Anesthesia Associates of New London, PC PastSince Dec 9, 2019 Accepting new patients

Locations

22725 US Highway 76
Clinton, SC 29325
Phone (864) 833-9100

1330 Taylor St
Columbia, SC 29201
Phone (803) 296-5137

701 Grove Rd
Greenville, SC 29605
Phone (864) 454-2030

100 Augusta St
Greenville, SC 29601
Phone (864) 455-2600

1 Independence Pt
Ste 212
Greenville, SC 29615
Phone (864) 797-6306

175 Patewood Dr
Greenville, SC 29615
Phone (864) 797-1000

200 Patewood Dr
Bldg A
Greenville, SC 29615
Phone (864) 454-2604

830 S Buncombe Rd
Greer, SC 29650
Phone (864) 797-8000

298 Memorial Dr
Seneca, SC 29672
Phone (864) 482-3100

729 SE Main St
Simpsonville, SC 29681
Phone (864) 271-8647

807 N Main St
Travelers Rst, SC 29690
Phone (864) 834-5132

1 Medical Park Blvd
Ste 210E
Bristol, TN 37620
Phone (423) 224-4000

1 Medical Park Blvd
Bristol, TN 37620
Phone (423) 390-0451

130 W Ravine Rd
Kingsport, TN 37660
Phone (423) 224-3150

10415 Wallace Alley St
Kingsport, TN 37663
Phone (423) 390-0451

9300 Park West Blvd
Knoxville, TN 37923
Phone (865) 427-4040

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 2

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": "1122595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1821098930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 URLACHER DR",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "371298998",
            "telephone_number": "615-796-0057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 COLLEGE ST",
            "address_2": "YALE NEW HAVEN HOSPITAL",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065118962",
            "telephone_number": "203-432-2700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1330 Taylor St",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292012915",
            "country_code": "US",
            "telephone_number": "803-296-5010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HALL",
        "first_name": "SHANNON D",
        "middle_name": "DALE",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-29",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "071173",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CT",
            "license": "003790",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "SC",
            "license": "20635",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "74007634",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3634996",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NUMBER",
            "identifier": "4072296",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.