Pebbles Dakota Shanley, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

108535 Issued in AK

Practice address

1201 E 36TH Ave
Anchorage, AK 99508-4372

Phone

(907) 562-9229

Fax

(907) 561-4806

NPI assigned

Jul 1, 2013

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

Other identifiers 1

Other names 1

• Pebbles Dakota Cody Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AK

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

Family Practice

Education

University of Texas Medical School at San Antonio, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Select Physical Therapy Holdings Inc 1,992 clinicians

Independence Park Medical Services Inc 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ancora Home Health & Hospice Home health agency, Wasilla, AK, CCN 027008
• Providence at Home With Compassus HH Anchorage Home health agency, Anchorage, AK, CCN 027001
• Providence Alaska Medical Center Hospital, Anchorage, AK, CCN 020001

Merit-based Incentive Payment System (MIPS)

Final score

88.88 of 100Reported as apm

Quality

71.03

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/fdbc9673-c618-4425-b458-9d4512be1bb3/

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.

• Independence Park Medical Services Inc

  • Multi-Specialty Clinic/Center
  • Anchorage, AK
  • NPI 1366435273

  AK, Family Medicine

  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ancora Home Health & Hospice, LLC

  • Home Health Agency
  • Wasilla, AK
  • NPI 1801380043
  Care Compare affiliation
• CP Ak HH, LLC

  • Home Health Agency
  • Anchorage, AK
  • NPI 1134941156
  Care Compare affiliation
• Providence Health & Services Washington

  • General Acute Care Hospital
  • Anchorage, AK
  • NPI 1053363119

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1372636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601596800000",
    "number": "1962842260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4105",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972084105",
            "telephone_number": "866-907-1068",
            "fax_number": "425-917-9141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 E 36TH AVE",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995084372",
            "telephone_number": "907-562-9229",
            "fax_number": "907-561-4806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANLEY",
        "first_name": "PEBBLES",
        "middle_name": "DAKOTA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-01",
        "last_updated": "2020-10-02",
        "certification_date": "2020-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AK",
            "license": "108535",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1597885",
            "state": "AK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pshanley298959@ak.providencedirect.org",
            "affiliation": "N",
            "address_1": "1201 E 36th Ave",
            "city": "Anchorage",
            "state": "AK",
            "country_code": "US",
            "postal_code": "995084372",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "PEBBLES",
            "last_name": "CODY",
            "middle_name": "DAKOTA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shalom and Chris Homes LLC
• Mikayla Shamburger, PT, DPT
• Gray Shaneberger, PA-C
• Michelle Shangin, MHPC
• Rex Charles Shangraw, BCBA
• Shannon Candid Alaska, P.C.
• Alexandra Ilona Shannon, OTD
• Charles Roy Shannon, MD
• John P Shannon Jr., D.C.
• Mary Hogg Shannon, PA

• All providers in Anchorage, AK
• Family Medicine Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2020; 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.