Martina Andrea Shannon, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

966 12TH St SE Ste 130
Salem, OR 97302-2860

Phone

(503) 837-6395

NPI assigned

Aug 18, 2025

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clear Choice DermatologyGroup PAC ID 4789005034, 47 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Clear Choice Dermatology

  • Dermatology Physician
  • The Dalles, OR
  • NPI 1891327185
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1755475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759881600000",
    "number": "1962389593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "966 12TH ST SE STE 130",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973022860",
            "telephone_number": "503-837-6395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "966 12TH ST SE STE 130",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973022860",
            "telephone_number": "503-837-6395"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2107 1st St",
            "address_purpose": "LOCATION",
            "city": "Eureka",
            "state": "CA",
            "postal_code": "955010840",
            "country_code": "US",
            "telephone_number": "707-273-6395",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "MARTINA",
        "middle_name": "ANDREA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-08-18",
        "last_updated": "2025-10-08",
        "certification_date": "2025-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shangri-la Corporation
• Shangri-la Corporation
• Danielle Sue Shannon, PHARMD, MSCR
• Jennifer Rose Shannon, LMFT
• Kendra Shannon, LPN
• William Shannon
• Kineret Shapira Sade
• Laura Camille Shapiro
• Sharing and Caring LLC
• Rakeshwar Sharma, QMHP-INTERN

• Physician Assistant in Salem, OR
• Providers in Salem, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2025; 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.