Shauna Pettis, ANP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

R215472 Issued in MD

Practice address

7450 Albert Rd FL 2
Brandywine, MD 20613-3035

Phone

(301) 888-2233

Fax

(301) 888-9133

NPI assigned

Nov 9, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DC, MD2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Maryland Medical Group LLCGroup PAC ID 5395893655, 21 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Southern Maryland Medical Group LLC

  • Internal Medicine Physician
  • Camp Springs, MD
  • NPI 1942448113

  DC

  Medicare reassignment Care Compare group NPD
• Greater Baden Medical Service Incorporated

  • Federally Qualified Health Center (FQHC)
  • Brandywine, MD
  • NPI 1912927344

  Adult Health, DC

  Medicare reassignment NPD
• Diversified Health and Supportive Services LLC

  • Home Health Agency
  • Mequon, WI
  • NPI 1225783913
  NPD Authorized official
• Greater Baden Medical Service Incorporated

  • Federally Qualified Health Center (FQHC)
  • Lexington Park, MD
  • NPI 1487469243
  NPD

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

{
    "created_epoch": "1257724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676505600000",
    "number": "1902133143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11207 BARNSWALLOW PL APT E",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034837",
            "telephone_number": "414-748-7776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7450 ALBERT RD FL 2",
            "city": "BRANDYWINE",
            "state": "MD",
            "postal_code": "206133035",
            "telephone_number": "301-888-2233",
            "fax_number": "301-888-9133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIS",
        "first_name": "SHAUNA",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-09",
        "last_updated": "2023-02-16",
        "certification_date": "2023-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MD",
            "license": "R215472",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "444563500",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Padgett
• Janese Parker
• Anish S. Patel, M.D., M.B.A
• Gregory John Peck
• Pediatrix Medical Group of the Mid-Atlantic PC
• Phoenix Freedom Foundation of MD, Inc
• Physician Imaging of Washington Hospital Center, LLC
• Physiocare Rehab & Wellness, LLC
• Katie Plitt, LPTA
• Mutiat O. Popoola, NURSE PRACTITIONER

• Adult Health Nurse Practitioner in Brandywine, MD
• Providers in Brandywine, MD by specialty
• Adult Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.