NPIMap

Individual provider Active NPI

Shannon Kloberdanz

  • Physician Assistant
  • Southfield, MI
National Provider Identifier
1912576463
Registry record updated Jun 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
27725 Greenfield Rd
Southfield, MI 48076
Phone
(248) 424-7159
NPI assigned
Jun 20, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

27725 Greenfield Rd
Southfield, MI 48076

Mailing address

27725 Greenfield Rd
Southfield, MI 48076
Phone (630) 340-2723

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20230616000876 MI Practitioner - Physician Assistant 7012375421 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Arcturus Healthcare PLCGroup PAC ID 7012143118, 63 clinicians

Practice addresses (Care Compare)

1701 S Blvd E
Rochester Hills, MI 48307-6116

4600 Investment Dr
Troy, MI 48098-6368
Phone 24826750003025

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.58 of 100Reported as group
Quality
82.27
Promoting interoperability
100
Improvement activities
40
Cost
69.67

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Macomb Oakland Adult Medicine PC Current Accepting new patients
Arcturus Healthcare PLC Past Accepting new patients

Locations

1701 South Blvd E
Ste 290
Rochester Hills, MI 48307
Phone (248) 997-7000

Interoperability endpoints

  • Direct secure messaging: skloberdanz867474@direct.hfhs.org
  • Direct secure messaging: shannonkloberdanz@timpc.allscriptsdirect.net

Organizations & group practices 2

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 5

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": "1624147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654473600000",
    "number": "1912576463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27725 GREENFIELD RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "48076",
            "telephone_number": "630-340-2723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27725 GREENFIELD RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "48076",
            "telephone_number": "248-424-7159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLOBERDANZ",
        "first_name": "SHANNON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-20",
        "last_updated": "2022-06-06",
        "certification_date": "2022-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.