Individual provider Active NPI

Shannon Yolanda Guo, O.D.

  • Optometrist
  • Seattle, WA
National Provider Identifier
1912320045
Registry record updated Apr 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
8580TG Issued in TX
Practice address
1420 5TH Ave Ste 375
Seattle, WA 98101-4032
Phone
(206) 223-2611
NPI assigned
Jan 24, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 8580TG TX Primary

Addresses

Primary practice location

1420 5TH Ave Ste 375
Seattle, WA 98101-4032

Mailing address

1420 5TH Ave Ste 375
Seattle, WA 98101-4032
Phone (206) 223-2611

Other identifiers 1

IdentifierTypeStateIssuer
343496101MedicaidTX

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180115000710 WA Practitioner - Optometry 1355665308 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Ohio State University - College of Optometry, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kaiser Foundation Health Plan of WashingtonGroup PAC ID 9032022579, 1,519 clinicians

Practice addresses (Care Compare)

301 S 320TH St
Federal Way, WA 98003-5200
Phone (253) 874-7000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8580TGTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of Washington CurrentSince Dec 12, 2017 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Dec 12, 2017 Accepting new patients
Kaiser Foundation Health Plan of Washington Current Accepting new patients

Locations

301 S 320th St
Federal Way, WA 98003
Phone (253) 874-7000

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

1420 5th Ave
Ste 375
Seattle, WA 98101
Phone (206) 223-2611

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

Interoperability endpoints

  • Direct secure messaging: sguo187885@ghc.direct-ci.net

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1390521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617840000000",
    "number": "1912320045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 5TH AVE STE 375",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981014032",
            "telephone_number": "206-223-2611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 5TH AVE STE 375",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981014032",
            "telephone_number": "206-223-2611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUO",
        "first_name": "SHANNON",
        "middle_name": "YOLANDA",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-24",
        "last_updated": "2021-04-08",
        "certification_date": "2021-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "8580TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "343496101",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1420 5th Ave Ste 375",
            "city": "Seattle",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981014032",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.