NPIMap

Individual provider Active NPI

Shannon Shafer, PA-C

  • Physician Assistant
  • Springfield, OH
National Provider Identifier
1952738148
Registry record updated Aug 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.003863 Issued in OH
Practice address
247 S Burnett Rd Ste 210
Springfield, OH 45505-2663
Phone
(937) 328-8850
Fax
(937) 328-8860
NPI assigned
Oct 2, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 19, 2019

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 50.003863 OH Primary

Addresses

Primary practice location

247 S Burnett Rd Ste 210
Springfield, OH 45505-2663

Mailing address

247 S Burnett Rd Ste 210
Springfield, OH 45505-2663
Phone (937) 328-8850

Other practice location 1

31 S Stanfield Rd
Ste 201
Troy, OH 45373
Phone (937) 440-7788

Other identifiers 1

IdentifierTypeStateIssuer
0092432MedicaidOH

Other names 1

  • Shannon Fuller Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20131022001118 OH Practitioner - Physician Assistant 4082849385 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Health Physicians Springfield Primary Care LLCGroup PAC ID 7315361359, 37 clinicians

Practice addresses (Care Compare)

900 Scioto St
Suite 4
Urbana, OH 43078-2251
Phone (937) 653-4666

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50.003863OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Physicians Cincinnati, LLC Physician Assistant CurrentSince Sep 1, 2019 Accepting new patients
Mercy Health Physicians Cincinnati LLC CurrentSince Sep 1, 2019 Accepting new patients

Locations

1701 Mercy Health Pl
Cincinnati, OH 45237
Phone (513) 952-5000

2446 Kipling Ave
Cincinnati, OH 45239
Phone (513) 583-8500

247 S Burnett Rd
Ste 210
Springfield, OH 45505
Phone (513) 328-8850

30 W McCreight Ave
Ste 110
Springfield, OH 45504
Phone (937) 399-2142

900 Scioto St
Ste 4
Urbana, OH 43078
Phone (937) 653-4666

Interoperability endpoints

  • Direct secure messaging: sshafer657482@direct.bsmhealth.org

Organizations & group practices 5

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 4

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": "1380672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566172800000",
    "number": "1952738148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "247 S BURNETT RD STE 210",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455052663",
            "telephone_number": "937-328-8850",
            "fax_number": "937-328-8860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "247 S BURNETT RD STE 210",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455052663",
            "telephone_number": "937-328-8850",
            "fax_number": "937-328-8860"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "31 S Stanfield Rd",
            "address_2": "Ste 201",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "OH",
            "postal_code": "45373",
            "country_code": "US",
            "telephone_number": "937-440-7788",
            "fax_number": "937-440-7243",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAFER",
        "first_name": "SHANNON",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-10-02",
        "last_updated": "2019-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.003863",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0092432",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "FULLER",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Springfield, OH

Sources for this page

Verify at the official NPI Registry.