Shannon Boese
Individual provider Active NPI Medical Physician Assistant · Whitefish, MT
NPI 1861944852 · NPPES record last updated Sep 22, 2020
Key facts
- NPI
- 1861944852
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- Practice address
- 1111 Baker Ave
Whitefish, MT 59937-2901 - Phone
- (406) 862-2515
- NPI assigned
- Oct 26, 2016
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171013002008 | MT | Practitioner - Physician Assistant | 2668752791 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Big Sandy Medical Center Inc | Current |
Accepting new patients | |
| Big Sandy Medical Center Inc | Current |
Accepting new patients | |
| Glacier Medical Associates | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | Yes |
Addresses
Primary practice location
1111 Baker Ave
Whitefish, MT 59937-2901
Mailing address
1129 Mackinaw Loop
Somers, MT 59932-9789
Phone (516) 320-5937
Other providers in Whitefish, MT
- Big Sky Therapy Associates, PLLP
- Robin Bissell
- Kyle Bitney
- Kurt E. Blades
- Erin Jensen Boedeker
- Corinne Bognacki
- Sara Boilen
- Sara L.S. Bonds
- Sarah Dawn Borders
- Jade Alexandria Bosic-Reiniger
All providers in Whitefish, MT · Medical Physician Assistant in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.