NPIMap

Individual provider Active NPI

Shannon Khulusi, NP

  • Family Nurse Practitioner
  • Eatontown, NJ
National Provider Identifier
1932240603
Registry record updated Feb 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
26NJ00061500 Issued in NJ
Practice address
142 State Route 35 S
Eatontown, NJ 07724-1876
Phone
(732) 389-5004
Fax
(732) 389-1850
NPI assigned
Feb 8, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 26NJ00061500 NJ
Family Nurse Practitioner 363LF0000X 26NJ00061500 NJ Primary

Addresses

Primary practice location

142 State Route 35 S
Eatontown, NJ 07724-1876

Mailing address

142 State Route 35 S
Eatontown, NJ 07724-1876
Phone (732) 389-5004

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20050415000539 NJ Practitioner - Nurse Practitioner 6507803095 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Allied Digestive Health LLCGroup PAC ID 5991027583, 282 clinicians

Practice addresses (Care Compare)

1640 Route 88 W 202
Atlantic Coast Gastroenterology Assoc
Brick, NJ 08724-3068
Phone (732) 458-8300

1945 Route 33
Ackerman 4
Neptune, NJ 07753
Phone (732) 776-4949

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
98.3 of 100Reported as group
Promoting interoperability
98
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
81.33 of 100Reported as group
Quality
66.38
Promoting interoperability
100
Improvement activities
40
Cost
71.39

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
26NJ00061500NJMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Allied Digestive Health, LLC CurrentSince Jan 1, 2015 Accepting new patients
Barnabas Health Medical Group, PC CurrentSince Dec 5, 2024 Accepting new patients
Hackensack Meridian Health Medical Group - Specialty Care PC CurrentSince Jan 27, 2024 Accepting new patients
Hackensack Meridian Health Medical Group - Specialty Care PC CurrentSince Jan 27, 2024 Accepting new patients
Atlantic Coast Gastroenterology Associates Past Accepting new patients
Hackensack Meridian Health Medical Group - Primary Care PC PastSince Jun 12, 2018 Accepting new patients

Locations

142 Highway 35
Eatontown, NJ 07724
Phone (732) 389-5004

98 James St
Ste 200
Edison, NJ 08820
Phone (732) 230-2828

30 Prospect Ave
Hackensack, NJ 07601
Phone (201) 488-0066

300 2nd Ave
Long Branch, NJ 07740
Phone (732) 222-5200

195 Route 9
Ste 106
Manalapan, NJ 07726
Phone (732) 360-3522

1270 State Route 35
Middletown, NJ 07748
Phone (732) 615-3900

1945 State Route 33
#4
Neptune, NJ 07753
Phone (732) 776-4949

201 Lyons Ave
Newark, NJ 07112
Phone (732) 923-7455

1912 State Route 35
Oakhurst, NJ 07755
Phone (732) 389-5004

1691 US Highway 9
Toms River, NJ 08755
Phone (732) 914-1688

1640 Route 88 W
Ste 202
Wall Township, NJ 08724
Phone (732) 370-2220

223 Monmouth Rd
West Long Branch, NJ 07764
Phone (732) 229-3838

187 State Route 36
Ste 230
West Long Branch, NJ 07764
Phone (732) 222-3805

Interoperability endpoints

  • Direct secure messaging: shannon.khulusi.1@24721.direct.athenahealth.com
  • FHIR API: https://mepic.hmhn.org/fhir/api/FHIR/R4/
  • FHIR API: https://fhir4.healow.com/fhir/r4/IHJHBD

Organizations & group practices 6

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 8

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": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740700800000",
    "number": "1932240603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "142 STATE ROUTE 35 S",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077241876",
            "telephone_number": "732-389-5004",
            "fax_number": "732-389-1850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "142 STATE ROUTE 35 S",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077241876",
            "telephone_number": "732-389-5004",
            "fax_number": "732-389-1850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHULUSI",
        "first_name": "SHANNON",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-08",
        "last_updated": "2025-02-28",
        "certification_date": "2025-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NJ",
            "license": "26NJ00061500",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ00061500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eatontown, NJ

Sources for this page

Verify at the official NPI Registry.