Active NPI
Shanae Mason, PA-C
- Physician Assistant
- Suwanee, GA
National Provider Identifier
1922557537
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 11060
- Practice address
- 1120 Peachtree Industrial Blvd
Suwanee, GA 30024-2013 - Phone
- (470) 326-5560
- NPI assigned
- Sep 23, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 1507 | SC | |
| Physician Assistant | 363A00000X | 11060 | GA | Primary |
Addresses
Primary practice location
1120 Peachtree Industrial Blvd
Suwanee, GA 30024-2013
Mailing address
2260 Hawks Bluff TRL
Lawrenceville, GA 30044-1812
Phone (843) 368-8355
Other practice location 1
990 Ribaut Rd
Beaufort, SC 29902-8011
Phone (843) 522-5965
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1507 | SC | MD | Athletic Trainer |
Organizations & group practices 1
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": "1474588800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659312000000",
"number": "1922557537",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2260 HAWKS BLUFF TRL",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300441812",
"telephone_number": "843-368-8355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1120 PEACHTREE INDUSTRIAL BLVD",
"city": "SUWANEE",
"state": "GA",
"postal_code": "300242013",
"telephone_number": "470-326-5560"
}
],
"practiceLocations": [
{
"address_1": "990 Ribaut Rd",
"address_purpose": "LOCATION",
"city": "Beaufort",
"state": "SC",
"postal_code": "299028011",
"country_code": "US",
"telephone_number": "843-522-5965",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MASON",
"first_name": "SHANAE",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-09-23",
"last_updated": "2022-08-01",
"certification_date": "2022-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "SC",
"license": "1507",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "11060",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Suwanee, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2022; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.