MR. SHANNON LEE SMITH PMHNP, MPH
NPI 1154686814
Nurse Practitioner - Psychiatric/Mental Health in Portland, OR

Q: What is Shannon Smith's NPI number?

The NPI number for Shannon Smith is 1154686814. It was assigned to this individual provider in the NPPES registry on July 9, 2012.

Q: What is Shannon Smith's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Q: When was this NPI record last updated?

The NPPES record for Shannon Smith was last updated on November 26, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.

Active since July 09, 2012PECOS EnrolledAccepts Medicare Assignment

619 NW 6TH AVE FL 3, PORTLAND, OR 97209(503) 988-5020(503) 988-5022 Get Directions Write a Review

NPPES record last updated: November 26, 2019. Verified against the NPPES registry weekly; last sync: September 27, 2026.

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About Mr. Shannon Lee Smith Pmhnp, Mph NPPES

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

MR. SHANNON LEE SMITH PMHNP, MPH (NPI 1154686814) is an individual psychiatric/mental health provider in Portland, Oregon, licensed in Oregon (201250082NP) and active in the NPI registry since July 2012. He is enrolled in Medicare PECOS and is a graduate of Other (2011).

NPPES Registry Identity

NPI1154686814

Entity TypeIndividualMale

Primary Taxonomy363LP0808X

Provider Legal NameMR. SHANNON LEE SMITHCredential: PMHNP, MPH

Location Address619 NW 6TH AVE FL 3Portland, OR 97209-3964

Mailing Address619 Nw 6th Ave Fl 5Portland, OR 97209-3964

Phone(503) 988-5020

Fax(503) 988-5022

Sole ProprietorNo

Medical School CMSOtherGraduated 2011

Enumeration DateJuly 9, 2012

Last NPPES UpdateNovember 26, 2019

✔ NPI 1154686814 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in OR · 201250082NP

619 NW 6TH AVE FL 3, Portland, OR 97209

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Other Identifiers 1

Medicaid22959OR

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, PacificSource Health Plans, Regence BlueCross BlueShield of Oregon.Insurance ›

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

Mr. Shannon Lee Smith Pmhnp, Mph 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 ID2668623224

PECOS Enrollment IDI20121108000498

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 97209 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

$90.51 typical visit price

range $58.99 – $176.88

Typical copayment $22.62 (range $14.74 – $44.22)

Most-billed visit code 99203

Established Patient

$103.51 typical visit price

range $19.32 – $144.79

Typical copayment $25.87 (range $4.83 – $36.19)

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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

Reported Quality Measures

Colorectal Cancer Screening

Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer

9%34 patients1/55-star benchmark: 85%

Documentation of Current Medications in the Medical Record

Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter.

14%264 patients1/55-star benchmark: 100%

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan

Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous…

43%91 patients2/55-star benchmark: 97%

Preventive Care and Screening: Influenza Immunization

Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization

82%79 patients4/55-star benchmark: 88%

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user

Patients screenedForUse: 98% · 59 patients

Patients tobacco: 95% · 59 patients

93%28 patients4/55-star benchmark: 98%

Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Other Providers at the Same Location NPPES 16

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

TREVIS JOSHUA HUTSELL RN, BSN

Registered Nurse (Community Health)