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DR. SHANNON L TILLY MD
NPI 1093767196
Obstetrics & Gynecology in Salt Lake City, UT

Active since May 17, 2006PECOS EnrolledAccepts Medicare Assignment
1525 W 2100 S, SALT LAKE CITY, UT 84119(801) 213-9900 Get Directions Write a Review

NPPES record last updated: August 10, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Dr. Shannon L Tilly Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. SHANNON L TILLY MD (NPI 1093767196) is an individual obstetrics & gynecology provider in Salt Lake City, Utah, licensed in Utah (54125001205) and active in the NPI registry since May 2006. She is enrolled in Medicare PECOS and is a graduate of University Of Colorado School Of Medicine, Denver (2002).

NPPES Registry Identity

NPI1093767196
Entity TypeIndividualFemale
Primary Taxonomy207V00000X
Provider Legal NameDR. SHANNON L TILLYCredential: MD
Location Address1525 W 2100 SSalt Lake City, UT 84119-1401
Mailing AddressPo Box 27128Salt Lake City, UT 84127-0128
Phone(801) 213-9900
Sole ProprietorNo
Medical School CMSUniversity Of Colorado School Of Medicine, DenverGraduated 2002
Enumeration DateMay 17, 2006
Last NPPES UpdateAugust 10, 2021
NPPES CertifiedAugust 10, 2021
✔ NPI 1093767196 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyObstetrics & GynecologyAllopathic & Osteopathic Physicians
Taxonomy Code207V00000X
License✔ Licensed in UT · 54125001205
Definition
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.
1525 W 2100 S, Salt Lake City, UT 84119
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Select Health.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Shannon L Tilly Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2668474404
PECOS Enrollment IDI20070208000131
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Shannon Tilly reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Ihc Health Services Inc
1.4 mi
Family Medicine
855 CALIFORNIA AVE
Salt Lake City, UT 84104
  • Reassigned Medicare billing, Utah enrollment
  • 3,691 clinicians in this Medicare group
NPI 1922367721 (801) 977-0502
University Of Utah Adult Services
5.4 mi
Sports Medicine
555 FOOTHILL DR
Salt Lake City, UT 84112
  • Reassigned Medicare billing, Utah enrollment
  • 2,620 clinicians in this Medicare group
NPI 1164826665 (801) 587-6336

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84119 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$125.70 typical visit price
range $54.34 – $166.03
Typical copayment $31.42 (range $13.58 – $41.50)
Most-billed visit code 99204
Established Patient
$68.01 typical visit price
range $17.23 – $135.20
Typical copayment $17.00 (range $4.30 – $33.80)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CYNTHIA M MATHEWSON MD
Family Medicine
1525 W 2100 S
SALT LAKE CITY, UT 84119
Salt Lake County (801) 887-2400
HUGH M STONEBURNER
Internal Medicine
1525 W 2100 S
SALT LAKE CITY, UT 84119
Salt Lake County (801) 581-2121
SUSAN HUCKENDUBLER STEPHENSON PHARM.D.
Pharmacist
1525 W 2100 S
SALT LAKE CITY, UT 84119
Salt Lake County (801) 213-9150
OUSSAMA HAMDOUN DAVIS INTERPRETER CERT.
Interpreter
1525 W 2100 S
SALT LAKE CITY, UT 84119
Salt Lake County (801) 213-9900
DANIEL MILES FIDLER
Nurse Practitioner (Family)
1525 W 2100 S
SALT LAKE CITY, UT 84119
Salt Lake County (801) 213-9900
DR. ELAINA G LINDBERG PHARMD
Pharmacist
1525 W 2100 S
SALT LAKE CITY, UT 84119
Salt Lake County (801) 213-9950
UNIVERSITY OF UTAH
Pharmacy (Community/Retail Pharmacy)
1525 W 2100 S
SALT LAKE CITY, UT 84119
Salt Lake County (801) 213-9950
UNIVERSITY OF UTAH COMMUNITY PHYSICIANS GROUP
General Practice
1525 W 2100 S
SALT LAKE CITY, UT 84119
Salt Lake County (801) 587-6336

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shannon Tilly's NPI number?

The NPI number for Shannon Tilly is 1093767196. It was assigned to this individual provider in the NPPES registry on May 17, 2006.

Where is Shannon Tilly located?

Shannon Tilly practices at 1525 W 2100 S, Salt Lake City, UT 84119. The listed phone number is (801) 213-9900.

What is Shannon Tilly's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology with taxonomy code 207V00000X.

Is Shannon Tilly enrolled in Medicare?

Yes. Shannon Tilly is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Shannon Tilly's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Shannon Tilly reassigns Medicare benefits to 2 organizations: Ihc Health Services Inc (Salt Lake City, UT) and University Of Utah Adult Services (Salt Lake City, UT). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Shannon Tilly's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Shannon Tilly accept?

Health plans from Select Health list Shannon Tilly as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Shannon Tilly was last updated on August 10, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.