Individual provider Active NPI

Grant Shannon, N.P.

  • Adult Health Nurse Practitioner
  • Plattsburgh, NY
National Provider Identifier
1881139863
Registry record updated May 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F308051-1 Issued in NY
Practice address
206 Cornelia St
Suite 105
Plattsburgh, NY 12901-2878
Phone
(518) 561-5516
NPI assigned
Dec 29, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X F308051-1 NY Primary

Addresses

Primary practice location

206 Cornelia St
Suite 105
Plattsburgh, NY 12901-2878

Mailing address

206 Cornelia St
Suite 105
Plattsburgh, NY 12901-2878
Phone (518) 561-5516

Other names 1

  • Mr. Patrick Grant Shannon Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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 1

Enrollment IDStateProvider typePAC IDDetails
I20170425000045 NY Practitioner - Nurse Practitioner 4486930641 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alice Hyde Medical CenterGroup PAC ID 4082525837, 88 clinicians

Practice addresses (Care Compare)

133 Park St
Malone, NY 12953-1243
Phone (518) 481-2545

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F308051-1NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Alice Hyde Medical Center CurrentSince May 1, 2019 Accepting new patients
Champlain Valley Physicians Hospital Medical Center CurrentSince Apr 1, 2017 Accepting new patients
Elizabethtown Community Hospital CurrentSince May 27, 2023 Accepting new patients
Elizabethtown Community Hospital CurrentSince May 27, 2023 Accepting new patients
Alice Hyde Medical Center Current Accepting new patients
Alice Hyde Medical Center Past Accepting new patients

Locations

969 State Route 11
Moira, NY 12957
Phone (518) 529-7847

206 Cornelia St
Ste 105
Plattsburgh, NY 12901
Phone (518) 314-3511

75 Beekman St
Plattsburgh, NY 12901
Phone (518) 562-7100

Interoperability endpoints

  • Direct secure messaging: gshannon465899@direct.uvmhealth.org
  • FHIR API: https://fhir-usa.unify.chbase.com/org/elizabe-e663f886

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 4

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": "1482969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494460800000",
    "number": "1881139863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 CORNELIA ST",
            "address_2": "SUITE 105",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129012878",
            "telephone_number": "518-561-5516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 CORNELIA ST",
            "address_2": "SUITE 105",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129012878",
            "telephone_number": "518-561-5516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "GRANT",
        "name_prefix": "Mr.",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-12-29",
        "last_updated": "2017-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F308051-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PATRICK",
            "last_name": "SHANNON",
            "middle_name": "GRANT",
            "prefix": "MR.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Plattsburgh, NY

Sources for this page

Verify at the official NPI Registry.