NPIMap

Individual provider Active NPI

Shannah Wick, PA

  • Physician Assistant
  • Spartanburg, SC
National Provider Identifier
1881971471
Registry record updated May 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3483 Issued in SC
Practice address
853 N Church St Ste 720C
Spartanburg, SC 29303-3003
Phone
(864) 560-6419
NPI assigned
Nov 9, 2011
Last updated
May 1, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2020

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 0010-03218 NC
Physician Assistant 363A00000X 3483 SC Primary

Addresses

Primary practice location

853 N Church St Ste 720C
Spartanburg, SC 29303-3003

Mailing address

PO Box 743070
Atlanta, GA 30374-3070

Other identifiers 2

IdentifierTypeStateIssuer
SCH4256066OtherSCMEDICARE PIN
2075PAMedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120117000738 NC Practitioner - Physician Assistant 4789851676 Reassigns benefits to 1 organization
I20200417002414 SC Practitioner - Physician Assistant 4789851676 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spartanburg Medical CenterGroup PAC ID 3072425297, 1,060 clinicians

Practice addresses (Care Compare)

101 E Wood St
Spartanburg, SC 29303-3040
Phone (864) 560-6193

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.7 of 100Reported as apm
Quality
89.4
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3483SCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Spartanburg Medical Center Current Accepting new patients
Spartanburg Medical Center CurrentSince Sep 1, 2025 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Jan 5, 2015 Accepting new patients
Spartanburg Medical Center CurrentSince Feb 3, 2020 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Jan 5, 2015 Accepting new patients
Spartanburg Medical Center CurrentSince Feb 3, 2020 Accepting new patients
Suncoast Medical, PC Past Accepting new patients
Buglisi Eye Care, PLLC Past Accepting new patients

Locations

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650

14214 Ballantyne Lake Rd
Ste 300
Charlotte, NC 28277
Phone (704) 446-5070

1124 N Washington St
Shelby, NC 28150
Phone (704) 487-1148

101 E Wood St
Spartanburg, SC 29303
Phone (864) 560-1915

101 E Wood St
Ste 300
Spartanburg, SC 29303
Phone (864) 560-6554

853 N Church St
Ste 410A
Spartanburg, SC 29303
Phone (864) 560-6928

853 N Church St
Ste 720C
Spartanburg, SC 29303
Phone (864) 560-6419

Organizations & group practices 10

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.

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": "1320796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588291200000",
    "number": "1881971471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743070",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303743070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "853 N CHURCH ST STE 720C",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293033003",
            "telephone_number": "864-560-6419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICK",
        "first_name": "SHANNAH",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-09",
        "last_updated": "2020-05-01",
        "certification_date": "2020-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-03218",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "3483",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "SCH4256066",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2075PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spartanburg, SC

Sources for this page

Verify at the official NPI Registry.