Shannon Lee Ruth Dieffenderfer

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

172156 Issued in AK

Practice address

4100 Lake Otis Pkwy Ste 108
Anchorage, AK 99508-5230

Phone

(907) 563-3145

Fax

(907) 561-3967

NPI assigned

Aug 17, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in GA, AK2 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

Philadelphia Col of Osteo Med, Sewanee, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tanana Valley Clinic LLCGroup PAC ID 5698056901, 142 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Fairbanks Memorial Hospital Hospital, Fairbanks, AK, CCN 020012

Merit-based Incentive Payment System (MIPS)

Final score

92.86 of 100Reported as group

Quality

94.88

Promoting interoperability

100

Improvement activities

40

Cost

79.39

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shannon.dieffenderfer.p1@direct.crossroadmc.nextgenshare.com
• Direct secure messaging: shannon.dieffenderfer@direct.tananavalley.nextgenshare.com

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.

• Tanana Valley Clinic LLC

  • Multi-Specialty Clinic/Center
  • Fairbanks, AK
  • NPI 1922559558
  Medicare reassignment Care Compare group NPD
• Anchorage Fracture and Orthopaedic Clinic, PC

  dba Alaska Fracture and Orthopedic Clinic

  • Orthopaedic Surgery Physician
  • Anchorage, AK
  • NPI 1285677054
  Medicare reassignment NPD
• Medical Network of Alaska, LLC

  dba Capstone Urgent Care

  • Urgent Care Clinic/Center
  • Wasilla, AK
  • NPI 1538414834
  Medicare reassignment
• Peachtree Immediate Care FP, LLC

  • Family Medicine Physician
  • Hiram, GA
  • NPI 1437194156
  Medicare reassignment
• Anchorage Fracture and Orthopaedic Clinic, PC

  • Durable Medical Equipment & Medical Supplies
  • Wasilla, AK
  • NPI 1831774298
  NPD
• Medical Network of Alaska, LLC

  dba Alaska Fracture and Orthopedic Clinic

  • Orthopaedic Surgery Physician
  • Anchorage, AK
  • NPI 1326753021
  NPD
• Medical Network of Alaska, LLC

  dba MNA Laboratory

  • Clinical Medical Laboratory
  • Wasilla, AK
  • NPI 1467167585
  NPD
• Medical Network of Alaska, LLC

  dba Resound ENT

  • Otolaryngology Physician
  • Anchorage, AK
  • NPI 1922862986
  NPD
• Tanana Valley Clinic LLC

  • Multi-Specialty Clinic/Center
  • Fairbanks, AK
  • NPI 1073081485
  NPD

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

• Fairbanks Memorial Hospital, LLC

  • General Acute Care Hospital
  • Fairbanks, AK
  • NPI 1720537178
  Care Compare affiliation

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

{
    "created_epoch": "1566000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654473600000",
    "number": "1861048530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 LAKE OTIS PKWY STE 108",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085230",
            "telephone_number": "907-563-3145",
            "fax_number": "907-561-3967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 LAKE OTIS PKWY STE 108",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085230",
            "telephone_number": "907-563-3145",
            "fax_number": "907-561-3967"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "187 Glenn Hwy",
            "address_purpose": "LOCATION",
            "city": "Glennallen",
            "state": "AK",
            "postal_code": "995880005",
            "country_code": "US",
            "telephone_number": "907-822-5686",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIEFFENDERFER",
        "first_name": "SHANNON",
        "middle_name": "LEE RUTH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-17",
        "last_updated": "2022-06-06",
        "certification_date": "2022-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "10117",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "172156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Y Dickerson, P.T.
• Elizabeth Dickeson
• Gilbert Dickie, M.D.
• Jessica Leanne Dickson
• Karen Kay Didrickson, RN, BSN
• Diehl Physical Therapy & Wellness, LLC
• Rainy Diehl, DPT
• Jennifer J Dieken, RN
• Marisha R Dieters, FNP
• Molly E. Dietrich, PSYD

• Physician Assistant in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Physician Assistant in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2022; 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.