NPIMap

Individual provider Active NPI

Shannon R Packer, PA-C

  • Medical Physician Assistant
  • Glastonbury, CT
National Provider Identifier
1861825259
Registry record updated Jul 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
23.002946 Issued in CT
Practice address
305 Western Blvd
Glastonbury, CT 06033-4380
Phone
(860) 522-0604
NPI assigned
Aug 20, 2013
Last updated
Jul 11, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2946 CT
Medical Physician Assistant 363AM0700X 23.002946 CT Primary

Addresses

Primary practice location

305 Western Blvd
Glastonbury, CT 06033-4380

Mailing address

305 Western Blvd
Glastonbury, CT 06033-4380
Phone (860) 522-0604

Other practice location 1

80 Seymour St
Hartford, CT 06102-8000
Phone (860) 972-4166

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131018000388 CT Practitioner - Physician Assistant 3173757531 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
87.73 of 100Reported as group
Quality
68.37
Promoting interoperability
100
Improvement activities
40
Cost
76.58

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2946CTMDPhysician Assistant
23.002946CTMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Healthcare Medical Group Specialists, PLLC CurrentSince Apr 7, 2025 Accepting new patients
Hartford Healthcare Medical Group Specialists LLC CurrentSince Apr 7, 2025 Accepting new patients
Midstate Medical Center CurrentSince May 18, 2025 Accepting new patients
Hartford Hospital CurrentSince Jul 17, 2023 Accepting new patients
Midstate Medical Center CurrentSince May 18, 2025 Accepting new patients
Hartford Hospital CurrentSince Jul 17, 2023 Accepting new patients
The Hospital of Central Connecticut at New Britain General and Bradley CurrentSince May 18, 2025 Accepting new patients
Connecticut Heart Physicians, Inc. PastSince Jul 24, 2006 Accepting new patients
Eastern Connecticut Medical Professionals Foundation, Inc Past Accepting new patients

Locations

100 Simsbury Rd
Avon, CT 06001
Phone (860) 659-8830

85 Seymour St
Ste 719
Hartford, CT 06106
Phone (860) 249-9175

435 Lewis Ave
Meriden, CT 06451
Phone (203) 284-1340

28 Crescent St
Middletown, CT 06457
Phone (860) 358-6000

100 Grand St
New Britain, CT 06052
Phone (860) 224-5011

1244 Storrs Rd
Storrs Mansfield, CT 06268
Phone (860) 724-2579

31 Union St
Vernon Rockvl, CT 06066
Phone (860) 289-6451

1290 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 972-6977

Interoperability endpoints

  • Direct secure messaging: shannon.packer.1@6291.direct.athenahealth.com
  • Direct secure messaging: shannon.packer@xdr.hhchealthdirect.org

Organizations & group practices 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1376956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689033600000",
    "number": "1861825259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 WESTERN BLVD",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060334380",
            "telephone_number": "860-522-0604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 WESTERN BLVD",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060334380",
            "telephone_number": "860-522-0604"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "80 Seymour St",
            "address_purpose": "LOCATION",
            "city": "Hartford",
            "state": "CT",
            "postal_code": "061028000",
            "country_code": "US",
            "telephone_number": "860-972-4166",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PACKER",
        "first_name": "SHANNON",
        "middle_name": "R",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-20",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "2946",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "23.002946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glastonbury, CT

Sources for this page

Verify at the official NPI Registry.