NPIMap

Individual provider Active NPI

Shannon L Gilliam, PA

  • Medical Physician Assistant
  • Waldorf, MD
National Provider Identifier
1972548584
Registry record updated Feb 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
C0003161 Issued in MD
Practice address
12070 Old Line Ctr Ste 303
Waldorf, MD 20602-3535
Phone
(301) 893-2505
NPI assigned
Jun 18, 2006
Last updated
Feb 24, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X C0003161 MD Primary

Addresses

Primary practice location

12070 Old Line Ctr Ste 303
Waldorf, MD 20602-3535

Mailing address

37855 Waterloo Rd
Coltons Point, MD 20626-2102
Phone (571) 215-2155

Other practice location 1

1500 Forest Glen Rd
Holy Corss Hospital
Silver Spring, MD 20910-1483
Phone (301) 754-7000 ext. 4284

Other names 1

  • Shannon L Zimmerman Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20060504000697 DC Practitioner - Physician Assistant 0042220014 Reassigns benefits to 3 organizations
I20060509000829 MD Practitioner - Physician Assistant 0042220014 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Capital Critical Care, LLCGroup PAC ID 6709037179, 21 clinicians

Practice addresses (Care Compare)

1500 Forest Glen Rd
Silver Spring, MD 20910-1460
Phone (410) 707-0102

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.34 of 100Reported as group
Quality
67.9
Promoting interoperability
100
Improvement activities
40
Cost
69.47

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C0003161MDMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Medstar Medical Group II LLC CurrentSince Dec 19, 2023 Accepting new patients
Medstar Medical Group II LLC CurrentSince Dec 19, 2023 Accepting new patients
Emergency Medicine Associates P.a., P.C. CurrentSince Sep 14, 2011 Accepting new patients
Emergency Medicine Associates PA CurrentSince Sep 14, 2011 Accepting new patients
Pediatrix Medical Group of the Mid-Atlantic PC Past Accepting new patients
Sunrise Medical Group, LLC PastSince Aug 15, 1998 Accepting new patients
Silver Spring Emergency Physicians, P.C. Past Accepting new patients

Locations

1145 19th St NW
Ste 311
Washington, DC 20036
Phone (202) 429-2401

7503 Surratts Rd
Clinton, MD 20735
Phone (301) 868-8000

701 Charles St
La Plata, MD 20646
Phone (301) 609-4000

41680 Miss Bessie Dr
Ste 202
Leonardtown, MD 20650
Phone (301) 475-3240

100 Hospital Rd
Prnc Frederck, MD 20678
Phone (410) 414-4791

200 Memorial Ave
Westminster, MD 21157
Phone (410) 848-3000

1701 N George Mason Dr
Arlington, VA 22205
Phone (703) 558-5000

Interoperability endpoints

  • Direct secure messaging: sgilliam682186@direct.umm.edu

Organizations & group practices 11

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.

Hospital & facility affiliations 2

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": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582502400000",
    "number": "1972548584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37855 WATERLOO RD",
            "city": "COLTONS POINT",
            "state": "MD",
            "postal_code": "206262102",
            "telephone_number": "571-215-2155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12070 OLD LINE CTR STE 303",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206023535",
            "telephone_number": "301-893-2505"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 Forest Glen Rd",
            "address_2": "Holy Corss Hospital",
            "address_purpose": "LOCATION",
            "city": "Silver Spring",
            "state": "MD",
            "postal_code": "209101483",
            "country_code": "US",
            "telephone_number": "301-754-7000 x4284",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GILLIAM",
        "first_name": "SHANNON",
        "middle_name": "L",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-18",
        "last_updated": "2020-02-24",
        "certification_date": "2020-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C0003161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "ZIMMERMAN",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Waldorf, MD

Sources for this page

Verify at the official NPI Registry.