NPIMap

Individual provider Active NPI

Shannon St John Fonger, FNP-C

  • Family Nurse Practitioner
  • Steamboat Springs, CO
National Provider Identifier
1992089676
Registry record updated Dec 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
990115 Issued in CO
Practice address
1024 Central Park Dr
Steamboat Springs, CO 80487-8813
Phone
(970) 870-1086
NPI assigned
Sep 29, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 4, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 178183 CO
Family Nurse Practitioner 363LF0000X 990115 CO Primary

Addresses

Primary practice location

1024 Central Park Dr
Steamboat Springs, CO 80487-8813

Mailing address

1024 Central Park Dr
Steamboat Springs, CO 80487-8813
Phone (970) 870-1086

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20111108000290 CO Practitioner - Nurse Practitioner 1850564824 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Yampa Valley Medical CenterGroup PAC ID 5890685689, 128 clinicians

Practice addresses (Care Compare)

1024 Central Park Dr
Steamboat SPR, CO 80487-8813
Phone (970) 879-1322

Hospital & facility affiliations

  • Uchealth Yampa Valley Medical Center Hospital, Steamboat Springs, CO, CCN 060049
  • Middle Park Medical Center Hospital, Kremmling, CO, CCN 061318
  • Memorial Hospital, the Hospital, Craig, CO, CCN 061314

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
178183COMDRegistered Nurse
990115COMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Yampa Valley Medical Center Current Accepting new patients
Yampa Valley Medical Center CurrentSince Apr 27, 2015 Accepting new patients
Yampa Valley Medical Center Past Accepting new patients

Locations

1024 Central Park Dr
Steamboat Springs, CO 80487
Phone (970) 824-1322

1100 Central Park Dr
Ste 2000
Steamboat Springs, CO 80487
Phone (970) 276-6239

Organizations & group practices 3

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 11

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": "1317254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449187200000",
    "number": "1992089676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1024 CENTRAL PARK DR",
            "city": "STEAMBOAT SPRINGS",
            "state": "CO",
            "postal_code": "804878813",
            "telephone_number": "970-870-1086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1024 CENTRAL PARK DR",
            "city": "STEAMBOAT SPRINGS",
            "state": "CO",
            "postal_code": "804878813",
            "telephone_number": "970-870-1086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONGER",
        "first_name": "SHANNON",
        "middle_name": "ST JOHN",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-29",
        "last_updated": "2015-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CO",
            "license": "178183",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "990115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Steamboat Springs, CO

Sources for this page

Verify at the official NPI Registry.