Shannon Grace Tisson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5770 Issued in CO

Practice address

2222 N Nevada Ave Ste 4007
Colorado Springs, CO 80907

Phone

(719) 776-8500

NPI assigned

Feb 5, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Shannon Lavelle Former name

Medicare fee-for-service enrollment

Enrolled in NY, TN2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• North Shore University Hospital Hospital, Manhasset, NY, CCN 330106

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H1722

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.

• North Shore-Lij Medical PC

  dba NHPP Cardiology at Great Neck

  • Urology Physician
  • Great Neck, NY
  • NPI 1053688572
  Medicare reassignment Care Compare group
• Vanderbilt University Medical Center

  dba Vanderbilt Medical Group

  • Internal Medicine Physician
  • Nashville, TN
  • NPI 1104202761
  Medicare reassignment NPD
• Samaritan Medical Services, P.C.

  • Internal Medicine Physician
  • West Islip, NY
  • NPI 1124184544
  Medicare reassignment

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

• North Shore University Hospital

  • General Acute Care Hospital
  • Manhasset, NY
  • NPI 1366459570
  Care Compare affiliation

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

{
    "created_epoch": "1454630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702771200000",
    "number": "1831557875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 COMMUNITY DR",
            "city": "MANHASSET",
            "state": "NY",
            "postal_code": "110303876",
            "telephone_number": "516-562-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 N NEVADA AVE STE 4007",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "80907",
            "telephone_number": "719-776-8500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1211 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "37232",
            "country_code": "US",
            "telephone_number": "615-322-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Port Washington Blvd",
            "address_purpose": "LOCATION",
            "city": "Roslyn",
            "state": "NY",
            "postal_code": "115761347",
            "country_code": "US",
            "telephone_number": "516-562-6000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1211 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "37232",
            "country_code": "US",
            "telephone_number": "615-322-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TISSON",
        "first_name": "SHANNON",
        "middle_name": "GRACE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-05",
        "last_updated": "2023-12-17",
        "certification_date": "2023-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "3496",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "23019471",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "5770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "LAVELLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Teresita Marie Tirona, MA, LPC
• Kristina Tischmak, RN, BSN
• Sara E. Tisdale, M.D.
• Barbara Candus Tise, LPC NCC
• Jayme R Tishon, MD
• Jessica Titone, LPCC
• Betsy Titus, PTA
• TJ's Safe Haven LLC
• TLC Speech & Language Therapy, Inc
• TLC Speech and Language Therapy, LLC

• Physician Assistant in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2023; 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.