SHANNA RACHELLE VIDOR M.D.
NPI 1215229729
Family Medicine in Nett Lake, MN
About Shanna Rachelle Vidor M.d. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SHANNA RACHELLE VIDOR M.D. (NPI 1215229729) is an individual family medicine provider in Nett Lake, Minnesota, licensed in Minnesota (55689) and active in the NPI registry since May 2011. She is enrolled in Medicare PECOS, is affiliated with Essentia Health St Mary's Medical Center, and is a graduate of University Of North Dakota School Of Medicine (2011).
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Other Identifiers 4
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
Shanna Rachelle Vidor M.d. 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.
Medicare Billing Reassignment
Medicare enrollment records show Shanna Vidor reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Nett Lake, MN 55772
- Reassigned Medicare billing, Minnesota enrollment
- 8 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims 9
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Hospital Affiliations CMS Care Compare 3
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Essentia Health St Mary's Medical Center
Acute Care Hospitals · Duluth, MNEssentia Health Virginia
Acute Care Hospitals · Virginia, MNCook Hospital
Critical Access Hospitals · Cook, MNPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 55772 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Referred Medical Equipment & Supplies CMS DME claims
Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.
Other Providers at the Same Location NPPES
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Shanna Vidor's NPI number?
The NPI number for Shanna Vidor is 1215229729. It was assigned to this individual provider in the NPPES registry on May 3, 2011. The provider is also known as Shanna Rachelle Landgren.
Where is Shanna Vidor located?
Shanna Vidor practices at 5219 St John Drive, Nett Lake, MN 55772. The listed phone number is (218) 757-3295.
What is Shanna Vidor's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Shanna Vidor enrolled in Medicare?
Yes. Shanna Vidor 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 Shanna Vidor's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Shanna Vidor reassigns Medicare benefits to Bois Forte Reservation Tribal Government (Nett Lake, MN). 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 Shanna Vidor's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
Is Shanna Vidor affiliated with any hospitals?
According to CMS data, Shanna Vidor is affiliated with Essentia Health St Mary's Medical Center, Essentia Health Virginia and Cook Hospital.
When was this NPI record last updated?
The NPPES record for Shanna Vidor was last updated on June 18, 2020. 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.
# Shanna Rachelle Vidor, M.D. · NPI 1215229729
Family Medicine physician in Nett Lake, Minnesota. Individual provider, active in the CMS NPPES registry since May 3, 2011.
## Identity
- **NPI:** 1215229729 (Entity type: Individual)
- **Enumerated:** May 3, 2011
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **State license:** 55689 (Minnesota)
- **Sole proprietor:** No
## Practice location
- **Address:** 5219 ST JOHN DRIVE, Nett Lake, MN 55772-8232
- **Phone:** (218) 757-3295
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Bois Forte Reservation Tribal Government (NPI 1073530150, Nett Lake, MN), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** University Of North Dakota School Of Medicine, class of 2011
## Record status
- **NPPES last updated:** June 18, 2020
- **Other identifiers:** Other 1215229729 (MN); Other 1215229729; Other P01105126 (MN); and 1 more
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Source: [NPI Profile](https://npiprofile.com/npi/1215229729) · Data from the CMS NPPES public registry.