Individual provider Active NPI

Shellane Marie Tangen, BSN, MSN, FNP-BC

  • Nurse Practitioner
  • Champaign, IL
National Provider Identifier
1841713450
Registry record updated Jul 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209015253 Issued in IL
Practice address
819 Bloomington Rd
Champaign, IL 61820-2101
Phone
(217) 356-1558
NPI assigned
Jul 25, 2017
Last updated
Jul 25, 2017By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 25, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209015253 IL Primary

Addresses

Primary practice location

819 Bloomington Rd
Champaign, IL 61820-2101

Mailing address

2183 Wagon Trail Rd
White Heath, IL 61884-9313
Phone (217) 621-6874

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20170915001583 IL Practitioner - Nurse Practitioner 4981978897 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

701 Devonshire Dr
Suite B14
Champaign, IL 61820-7328
Phone (877) 448-3627

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor on Science - Nursing, Master of Science - Nursing, Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Metro Infectious Disease Consultants, LLC Nurse Practitioner CurrentSince Jan 1, 2023 Accepting new patients
Promise Healthcare NFP Current Accepting new patients
Metro Infectious Disease Consultants LLC CurrentSince Jan 1, 2023 Accepting new patients
Promise Healthcare NFP CurrentSince Aug 22, 2017 Accepting new patients
Promise Healthcare NFP CurrentSince Aug 22, 2017 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

400 Remington Blvd
Bolingbrook, IL 60440
Phone (630) 226-8100

901 McClintock Dr
Ste 202
Burr Ridge, IL 60527
Phone (630) 654-4201

310 W Plaza Dr
Carterville, IL 62918
Phone (618) 525-0719

701 Devonshire Dr
Ste B14
Champaign, IL 61820

819 Bloomington Rd
Champaign, IL 61820
Phone (217) 356-1558

1435 N Randall Rd
Ste 404
Elgin, IL 60123
Phone (847) 741-5091

1351 Hickory Point Dr
Forsyth, IL 62535

555 W Court St
Ste 108
Kankakee, IL 60901
Phone (815) 932-7929

1300 Franklin Ave
Ste 230C
Normal, IL 61761
Phone (309) 585-6029

Interoperability endpoints

  • Direct secure messaging: shelly.tangen.p11@direct.fhn-fqhc.nextgenshare.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1500940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1500940800000",
    "number": "1841713450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2183 WAGON TRAIL RD",
            "city": "WHITE HEATH",
            "state": "IL",
            "postal_code": "618849313",
            "telephone_number": "217-621-6874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "819 BLOOMINGTON RD",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618202101",
            "telephone_number": "217-356-1558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANGEN",
        "first_name": "SHELLANE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "BSN, MSN, FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-25",
        "last_updated": "2017-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209015253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Champaign, IL

Sources for this page

Verify at the official NPI Registry.