Shannon B. Beausoleil I, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

043733 Issued in CT

Practice address

1216 Farmington Ave Ste 202
West Hartford, CT 06107-2673

Phone

(860) 236-0331

Fax

(860) 263-8697

NPI assigned

Nov 2, 2005

Last updated

Jun 22, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal MedicineAlso: Pediatric Medicine

Education

University of Connecticut School of Medicine, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Collins Medical Associates 2 PCGroup PAC ID 3779486345, 43 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/27673/brand/1/csg/1/fhir/r4
• Direct secure messaging: sbeausoleil12499@direct.stfranciscare.org
• Direct secure messaging: shannon.beausoleil.1@27673.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Collins Medical Associates 2 PC

  • Internal Medicine Physician
  • Hartford, CT
  • NPI 1912928169
  Medicare reassignment Care Compare group NPD
• Collins Medical Associates 2 PC

  • Internal Medicine Physician
  • Hartford, CT
  • NPI 1518256452
  NPD
• Johnson Professional Associates, PC

  • Hospitalist Physician
  • Stafford Springs, CT
  • NPI 1770564262

  Internal Medicine

  NPD (past)
• Trinity Health of New England Provider Network Organization Inc

  dba Trinity Health Of New England Medical Group

  • Internal Medicine Physician
  • Hartford, CT
  • NPI 1003882812
  NPD (past)

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624320000000",
    "number": "1942291653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1216 FARMINGTON AVE STE 202",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061072673",
            "telephone_number": "860-236-0331",
            "fax_number": "860-263-8697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1216 FARMINGTON AVE STE 202",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061072673",
            "telephone_number": "860-236-0331",
            "fax_number": "860-263-8697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEAUSOLEIL",
        "first_name": "SHANNON",
        "middle_name": "B.",
        "name_suffix": "I",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-02",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "043733",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "043733",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sbeausoleil12499@direct.stfranciscare.org",
            "affiliation": "N",
            "endpointDescription": "Saint Francis Direct address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1216 Farmington Ave Ste 202",
            "city": "West Hartford",
            "state": "CT",
            "country_code": "US",
            "postal_code": "061072673",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Katherine Batten, LCSW
• Christine Haverly Baumgart, IBCLC
• Andrea Loftus Bayley, LCSW
• Be Mindful Clinic LLC
• Deborah Elizabeth Beach
• Beautiful Mind Counseling Services LLC
• Amy Eklund Beauvais, DMD
• Daniel Beauvais, DMD, MD
• John Beazoglou, LCSW
• Leah Beck

• Pediatrics Physician in West Hartford, CT
• Providers in West Hartford, CT by specialty
• Pediatrics Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.