NPIMap

Individual provider Active NPI

Shannon J. Reinbold, M.D.

  • Internal Medicine Physician
  • Grafton, WI
National Provider Identifier
1912065855
Registry record updated Mar 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
20339-20 Issued in WI
Practice address
2061 Cheyenne Court
Grafton, WI 53024-9368
Phone
(262) 376-1934
Fax
(262) 375-2076
NPI assigned
Dec 4, 2006
Last updated
Mar 18, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 20339-20 WI Primary
Pediatrics Physician 208000000X 50339-20 WI

Addresses

Primary practice location

2061 Cheyenne Court
Grafton, WI 53024-9368

Mailing address

4425 N Port Washington Road, 3Rd Floor
Csmcp Clinic Credentialing
Glendale, WI 53212-1082
Phone (414) 326-2378

Other names 1

  • Shannon M. Johnson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20091019000343 WI Practitioner - Internal Medicine 8325185614 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Saint Louis University School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2061 Cheyenne CT
Grafton, WI 53024-9368
Phone (262) 376-1934

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
50339-20WIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia St. Mary's Hospital Milwaukee, Inc CurrentSince Dec 30, 2022 Accepting new patients
Columbia St. Mary's Hospital Milwaukee Inc CurrentSince Dec 30, 2022 Accepting new patients
Sacred Heart Rehabilitation Institute, Inc Past Accepting new patients
Columbia St. Mary's Hospital Milwaukee, Inc Past Accepting new patients

Locations

N112W15415 Mequon Rd
Germantown, WI 53022
Phone (262) 250-7800

2061 Cheyenne Ct
Grafton, WI 53024
Phone (262) 243-4924

13111 N Port Washington Rd
Thiensville, WI 53097
Phone (262) 243-7300

801 S 70th St
West Allis, WI 53214
Phone (414) 773-6600

Organizations & group practices 4

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": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395100800000",
    "number": "1912065855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 N PORT WASHINGTON ROAD, 3RD FLOOR",
            "address_2": "CSMCP CLINIC CREDENTIALING",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532121082",
            "telephone_number": "414-326-2378",
            "fax_number": "414-326-2155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2061 CHEYENNE COURT",
            "city": "GRAFTON",
            "state": "WI",
            "postal_code": "530249368",
            "telephone_number": "262-376-1934",
            "fax_number": "262-375-2076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REINBOLD",
        "first_name": "SHANNON",
        "middle_name": "J.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-04",
        "last_updated": "2014-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "20339-20",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "50339-20",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "JOHNSON",
            "middle_name": "M.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Grafton, WI

Sources for this page

Verify at the official NPI Registry.