NPIMap

Individual provider Active NPI

Shannon Marie Convery, PA-C

  • Medical Physician Assistant
  • Lorain, OH
National Provider Identifier
1871803676
Registry record updated Nov 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
50.002241 Issued in OH
Practice address
5172 Leavitt Rd
Lorain, OH 44053-2384
Phone
(440) 282-3385
NPI assigned
Oct 14, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA03157 TX
Physician Assistant 363A00000X 1052607 NCCPA NUMBER TX
Medical Physician Assistant 363AM0700X 50.002241 OH Primary

Addresses

Primary practice location

5172 Leavitt Rd
Lorain, OH 44053-2384

Mailing address

4211 Wooster Rd
Fairview Park, OH 44126-3417
Phone (440) 289-7243

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address shannonconvery@uhps.allscriptsdirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20141027001815 OH Practitioner - Physician Assistant 4385865880 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

158 W Main Rd
Conneaut, OH 44030-2039

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1052607 NCCPA NUMBERTXMDPhysician Assistant
50.002241OHMDMedical Physician Assistant
PA03157TXMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University Primary Care Practices Inc CurrentSince Dec 8, 2014 Accepting new patients
The Cleveland Clinic Foundation CurrentSince Sep 23, 2014 Accepting new patients
University Primary Care Practices Inc CurrentSince Dec 8, 2014 Accepting new patients
University Hospitals Medical Group Inc Past Accepting new patients
University Primary Care Practices Past Accepting new patients

Locations

254 Cleveland Ave
Ste 101
Amherst, OH 44001
Phone (440) 723-5685

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270

158 W Main Rd
Ste 203
Conneaut, OH 44030
Phone (440) 285-2960

5172 Leavitt Rd
Lorain, OH 44053
Phone (440) 282-7420

Interoperability endpoints

  • Direct secure messaging: sconvery28486@ehrdirect.uhhospitals.org

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1287014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605657600000",
    "number": "1871803676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4211 WOOSTER RD",
            "city": "FAIRVIEW PARK",
            "state": "OH",
            "postal_code": "441263417",
            "telephone_number": "440-289-7243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5172 LEAVITT RD",
            "city": "LORAIN",
            "state": "OH",
            "postal_code": "440532384",
            "telephone_number": "440-282-3385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONVERY",
        "first_name": "SHANNON",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-14",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA03157",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "1052607 NCCPA NUMBER",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OH",
            "license": "50.002241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "shannonconvery@uhps.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "254 Cleveland Ave Ste 101",
            "city": "Amherst",
            "state": "OH",
            "country_code": "US",
            "postal_code": "440011620",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lorain, OH

Sources for this page

Verify at the official NPI Registry.