Shannon Bottari, MD
Individual provider Active NPI Emergency Medicine Physician · Melrose, MA
NPI 1922020353 · NPPES record last updated Apr 23, 2008
Key facts
- NPI
- 1922020353
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 225017 (MA)
- Practice address
- 585 Lebanon St
Melrose, MA 02176-3225 - Phone
- (781) 937-4522
- NPI assigned
- Jul 24, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Emergency Medicine
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Hallmark Health Urgent Care Physicians LLC
Melrose Wakefield Emergency Physicians, Inc
Practice addresses (Care Compare)
170 Governors Ave
Medford, MA 02155-1643
Phone (781) 979-3000
30 New Crossing Rd
Reading, MA 01867-3270
Phone (781) 213-5500
585 Lebanon St
Melrose, MA 02176-3225
Phone (781) 979-3086
Hospital & facility affiliations
- Melrosewakefield Healthcare
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061227000138 | MA | Practitioner - Emergency Medicine | 1052311958 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 225017 | MA | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Melrose Wakefield Emergency Physicians, Inc. | Emergency Medicine | Current |
Accepting new patients |
| Hallmark Health Urgent Care Physicians LLC | Emergency Medicine | Current |
Accepting new patients |
Locations
585 Lebanon St
Melrose, MA 02176
Phone (781) 979-3026
30 New Crossing Rd
Reading, MA 01867
Phone (781) 213-5150
Interoperability endpoints
- sbottari28533@tuftsmedicine.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 225017 | MA | Yes |
Addresses
Primary practice location
585 Lebanon St
Melrose, MA 02176-3225
Mailing address
12 Gill St
Ste 3000
Woburn, MA 01801-1728
Phone (781) 937-4522
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| J40959 | Other | MA | BLUE SHIELD |
| 2126966 | Medicaid | MA |
Other providers in Melrose, MA
- Mayra Bolden
- Katrina Daigle Borden
- Ilana Bortinger
- Boston Pain Specialist, PC
- Boston Pelvic Physical Therapy
- Jillian M Boyle
- Bridget Riley Braverman
- Sara Breglio
- Brewer Nystuen Pediatrics
- Matthew Philip Brewer
All providers in Melrose, MA · Emergency Medicine Physician in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 23, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.