Active NPI
Shannon Rebecca Jacobs, PA-C
- Physician Assistant
- Kansas City, MO
National Provider Identifier
1841821113
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 2022009841
- Practice address
- 2401 Gillham Rd
Kansas City, MO 64108-4619 - Phone
- (816) 234-3000
- Fax
- (816) 302-9939
- NPI assigned
- Jan 27, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2022009841 | MO | Primary |
Addresses
Primary practice location
2401 Gillham Rd
Kansas City, MO 64108-4619
Mailing address
2401 Gillham Rd
Kansas City, MO 64108-4619
Phone (816) 701-5200
Other names 1
- Shannon Rebecca Pulliam
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KS, MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Optum Medical Group P a | Current | Accepting new patients | |
| Hormazd Sanjana M.D., P.a. | Past | Accepting new patients | |
| The Children'S Mercy Hospital | Past | Accepting new patients |
Locations
6860 W 115th St
Overland Park, KS 66211
Phone (800) 645-9656
9229 Ward Pkwy
Kansas City, MO 64114
Phone (816) 444-5511
Interoperability endpoints
- shannon.jacobs.1@16107.direct.athenahealth.com
Organizations & group practices 3
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.
-
- Family Medicine Physician
- San Antonio, TX
- NPI 1407082373
-
- Children's Hospital
- Overland Park, KS
- NPI 1154400232
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580083200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753142400000",
"number": "1841821113",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2401 GILLHAM RD",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641084619",
"telephone_number": "816-701-5200",
"fax_number": "816-302-9939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2401 GILLHAM RD",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641084619",
"telephone_number": "816-234-3000",
"fax_number": "816-302-9939"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "SHANNON",
"middle_name": "REBECCA",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-27",
"last_updated": "2025-07-22",
"certification_date": "2025-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MO",
"license": "2022009841",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SHANNON",
"last_name": "PULLIAM",
"middle_name": "REBECCA",
"credential": "PA-C",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Kansas City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2025; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.