SHANE BANNON
NPI 1245997220
Nurse Practitioner - Acute Care in Philadelphia, PA

Q: What is Shane Bannon's NPI number?

The NPI number for Shane Bannon is 1245997220. It was assigned to this individual provider in the NPPES registry on November 24, 2021.

Q: What is Shane Bannon's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Acute Care, with taxonomy code 363LA2100X.

Q: When was this NPI record last updated?

The NPPES record for Shane Bannon was last updated on November 24, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since November 24, 2021PECOS EnrolledAccepts Medicare Assignment

1 CONVENTION AVE, PHILADELPHIA, PA 19104(800) 789-7366 Get Directions Write a Review

NPPES record last updated: November 24, 2021. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Shane Bannon NPPES

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

SHANE BANNON (NPI 1245997220) is an individual acute care provider in Philadelphia, Pennsylvania, licensed in Pennsylvania (SP024901) and active in the NPI registry since November 2021. He is enrolled in Medicare PECOS, is affiliated with Hospital Of Univ Of Pennsylvania, and is a graduate of Other (2021).

NPPES Registry Identity

NPI1245997220

Entity TypeIndividualMale

Primary Taxonomy363LA2100X

Provider Legal NameSHANE BANNON

Location Address1 CONVENTION AVEPhiladelphia, PA 19104-4311

Mailing Address285 Birch DrLafayette Hill, PA 19444-2103

Phone(800) 789-7366

Sole ProprietorYes

Medical School CMSOtherGraduated 2021

Enumeration DateNovember 24, 2021

NPPES CertifiedNovember 15, 2021

✔ NPI 1245997220 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Acute CarePhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LA2100X

License✔ Licensed in PA · SP024901

1 CONVENTION AVE, Philadelphia, PA 19104

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

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

Shane Bannon 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 ID9133513518

PECOS Enrollment IDI20220301000914

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.

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Hospital Of Univ Of Pennsylvania

Acute Care Hospitals · Philadelphia, PA

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number390111

Location34th & Spruce StsPhiladelphia, PA 19104 · Philadelphia County

Emergency services Birthing friendly

Chester County Hospital

Acute Care Hospitals · West Chester, PA

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number390179

Location701 East Marshall StreetWest Chester, PA 19380 · Chester County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 19104 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

$92.69 typical visit price

range $59.88 – $180.99

Typical copayment $23.17 (range $14.97 – $45.24)

Most-billed visit code 99203

Established Patient

$105.21 typical visit price

range $19.30 – $147.29

Typical copayment $26.30 (range $4.82 – $36.82)

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.

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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.

TIFFANY GARDNER

Pharmacist