MRS. SHANNON MARIE MCGOURN APRN
NPI 1104680644
Nurse Practitioner - Family in Waterbury, CT

Q: What is Shannon Mcgourn's NPI number?

The NPI number for Shannon Mcgourn is 1104680644. It was assigned to this individual provider in the NPPES registry on February 6, 2024.

Q: What is Shannon Mcgourn's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Shannon Mcgourn was last updated on March 11, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months 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.

Active since February 06, 2024PECOS EnrolledAccepts Medicare Assignment

1279 W MAIN ST, WATERBURY, CT 06708(203) 755-5490 Get Directions Write a Review

NPPES record last updated: March 11, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Mar 11, 2026, Feb 6, 2024 (2 updates tracked since 2024).

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About Mrs. Shannon Marie Mcgourn Aprn NPPES

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

MRS. SHANNON MARIE MCGOURN APRN (NPI 1104680644) is an individual family provider in Waterbury, Connecticut, licensed in Connecticut (F01241425) and active in the NPI registry since February 2024. She is enrolled in Medicare PECOS and is a graduate of Other (2023).

NPPES Registry Identity

NPI1104680644

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameMRS. SHANNON MARIE MCGOURNCredential: APRN

Location Address1279 W MAIN STWaterbury, CT 06708-3101

Mailing Address785 Old Turnpike RdPlantsville, CT 06479-1715

Phone(203) 755-5490

Sole ProprietorNo

Medical School CMSOtherGraduated 2023

Enumeration DateFebruary 6, 2024

Last NPPES UpdateMarch 11, 20262 updates tracked since enumeration

NPPES CertifiedMarch 11, 2026

✔ NPI 1104680644 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in CT · F01241425

1279 W MAIN ST, Waterbury, CT 06708

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mrs. Shannon Marie Mcgourn Aprn 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 ID6901393784

PECOS Enrollment IDI20251015001193

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 06708 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

$93.86 typical visit price

range $60.82 – $183.10

Typical copayment $23.46 (range $15.20 – $45.77)

Most-billed visit code 99203

Established Patient

$106.68 typical visit price

range $19.76 – $149.26

Typical copayment $26.67 (range $4.94 – $37.31)

Most-billed visit code 99214

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 14

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

XHENSILA ALICKOLLI

Pharmacist