SHANE THOMAS GONNELLY PA-C
NPI 1275413189
Physician Assistant in Spearfish, SD

Q: What is Shane Gonnelly's NPI number?

The NPI number for Shane Gonnelly is 1275413189. It was assigned to this individual provider in the NPPES registry on September 3, 2025.

Q: What is Shane Gonnelly's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Shane Gonnelly was last updated on September 3, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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 September 03, 2025PECOS EnrolledAccepts Medicare Assignment

2479 E COLORADO BLVD, SPEARFISH, SD 57783(605) 644-4460 Get Directions Write a Review

NPPES record last updated: September 3, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Shane Thomas Gonnelly Pa-c NPPES

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

SHANE THOMAS GONNELLY PA-C (NPI 1275413189) is an individual physician assistant in Spearfish, South Dakota, licensed in South Dakota (1635) and active in the NPI registry since September 2025. He is enrolled in Medicare PECOS, is affiliated with Monument Health Spearfish Hospital, and is a graduate of Other (2025).

NPPES Registry Identity

NPI1275413189

Entity TypeIndividualMale

Primary Taxonomy363A00000X

Provider Legal NameSHANE THOMAS GONNELLYCredential: PA-C

Location Address2479 E COLORADO BLVDSpearfish, SD 57783-3204

Mailing Address1003 21st St NeWatertown, SD 57201-6700

Phone(605) 644-4460

Sole ProprietorNo

Medical School CMSOtherGraduated 2025

Enumeration DateSeptember 3, 2025

NPPES CertifiedSeptember 3, 2025

✔ NPI 1275413189 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in SD · 1635

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

2479 E COLORADO BLVD, Spearfish, SD 57783

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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

Shane Thomas Gonnelly Pa-c 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 ID3971096215

PECOS Enrollment IDI20251204001354

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

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

Monument Health Spearfish Hospital

Acute Care Hospitals · Spearfish, SD

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number430048

Location1440 N Main StSpearfish, SD 57783 · Lawrence County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 57783 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

$85.21 typical visit price

range $55.52 – $167.23

Typical copayment $21.30 (range $13.88 – $41.80)

Most-billed visit code 99203

Established Patient

$69.20 typical visit price

range $18.08 – $137.08

Typical copayment $17.30 (range $4.52 – $34.27)

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.

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.

DR. MARK T. BUCHMAN MD

Orthopaedic Surgery (Hand Surgery)