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SHANNON DEXTER PETROVICH LCSW, LISAC
NPI 1104374255
Social Worker - Clinical in Tucson, AZ

Active since September 19, 2016PECOS EnrolledAccepts Medicare Assignment
5855 N KOLB RD UNIT 4208, TUCSON, AZ 85750(520) 909-4740 Get Directions Write a Review

NPPES record last updated: September 19, 2016. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Shannon Dexter Petrovich Lcsw, Lisac NPPES

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

SHANNON DEXTER PETROVICH LCSW, LISAC (NPI 1104374255) is an individual clinical provider in Tucson, Arizona, licensed in Arizona (LCSW-4024) and active in the NPI registry since September 2016. She is enrolled in Medicare PECOS and is a graduate of Other (1988).

NPPES Registry Identity

NPI1104374255
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameSHANNON DEXTER PETROVICHCredential: LCSW, LISAC
Location Address5855 N KOLB RD UNIT 4208Tucson, AZ 85750-0991
Mailing Address5855 N Kolb Rd Unit 4208Tucson, AZ 85750-0991 · (520) 909-4740
Phone(520) 909-4740
Sole ProprietorYes
Medical School CMSOtherGraduated 1988
Enumeration DateSeptember 19, 2016
✔ NPI 1104374255 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in AZ · LCSW-4024
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License LISAC-1365 (AZ)
5855 N KOLB RD UNIT 4208, Tucson, AZ 85750
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter Health, Blue Cross Blue Shield of Arizona and more.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

Shannon Dexter Petrovich Lcsw, Lisac 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 ID7719941293
PECOS Enrollment IDI20041115000769
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 Reassignment

Medicare enrollment records show Shannon Petrovich reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Aleph Center, P.L.L.C.
5.0 mi
Psychiatry
6408 E TANQUE VERDE RD
Tucson, AZ 85715
  • Reassigned Medicare billing, Arizona enrollment
  • 19 clinicians in this Medicare group
NPI 1215022157 (520) 885-5558

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 85750 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
$0.00 typical visit price
range $55.44 – $168.60
Typical copayment $0.00 (range $13.86 – $42.15)
Most-billed visit code NA
Established Patient
$69.24 typical visit price
range $17.72 – $137.41
Typical copayment $17.31 (range $4.43 – $34.35)
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.

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 Petrovich's NPI number?

The NPI number for Shannon Petrovich is 1104374255. It was assigned to this individual provider in the NPPES registry on September 19, 2016.

Where is Shannon Petrovich located?

Shannon Petrovich practices at 5855 N Kolb Rd Unit 4208, Tucson, AZ 85750. The listed phone number is (520) 909-4740.

What is Shannon Petrovich's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Shannon Petrovich enrolled in Medicare?

Yes. Shannon Petrovich 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 organization bills Medicare for Shannon Petrovich's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Shannon Petrovich reassigns Medicare benefits to Aleph Center, P.L.L.C. (Tucson, AZ). The 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 Petrovich's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Shannon Petrovich accept?

Health plans from Ambetter Health, Ambetter from Arizona Complete Health, Blue Cross Blue Shield of Arizona and Cigna HealthCare of Arizona, Inc list Shannon Petrovich 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 Petrovich was last updated on September 19, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.