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SHANNON DEROSE RPA-C
NPI 1407004898
Physician Assistant - Surgical in Rochester, NY

Active since August 28, 2008PECOS EnrolledAccepts Medicare Assignment
95.19/100
CMS Quality Rating
125 RED CREEK DR STE 205, ROCHESTER, NY 14623(585) 723-7600(585) 334-6373 Get Directions Write a Review

NPPES record last updated: September 14, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 14, 2022, Mar 17, 2018, Oct 27, 2017 (3 updates tracked since 2017).

About Shannon Derose Rpa-c NPPES

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

SHANNON DEROSE RPA-C (NPI 1407004898) is an individual surgical provider in Rochester, New York, licensed in New York (012694) and active in the NPI registry since August 2008. She is enrolled in Medicare PECOS, is affiliated with Rochester General Hospital, and maintains a secondary practice location in Rochester.

NPPES Registry Identity

NPI1407004898
Entity TypeIndividualFemale
Primary Taxonomy363AS0400X
Provider Legal NameSHANNON DEROSECredential: RPA-C
Location Address125 RED CREEK DR STE 205Rochester, NY 14623-4262
Mailing Address1555 Long Pond RdRochester, NY 14626-4122 · (585) 723-7281 · Fax (585) 723-8660
Phone(585) 723-7600
Fax(585) 334-6373
Sole ProprietorNo
Medical School CMSOtherGraduated 2008
Enumeration DateAugust 28, 2008
Last NPPES UpdateSeptember 14, 20223 updates tracked since enumeration
NPPES CertifiedSeptember 14, 2022
✔ NPI 1407004898 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AS0400X
License✔ Licensed in NY · 012694
125 RED CREEK DR STE 205, Rochester, NY 14623
Open in Google Maps ↗

Other Names 1

Former Name (1)Shannon Parker

Secondary Practice Location 1

Location 12115 Chili AveRochester, NY 14624-3425 · Phone (585) 723-7600 · Fax (585) 247-0075

Other Identifiers 1

Medicaid03607632NY

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

Shannon Derose Rpa-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 ID7810058617
PECOS Enrollment IDI20081212000056
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.

Rochester General Hospital

Acute Care Hospitals · Rochester, NY
2/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number330125
Location1425 Portland AvenueRochester, NY 14621 · Monroe County
Emergency services Birthing friendly

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.

95.19/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality70.62
Promoting Interoperability100
Improvement Activities40

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 Shannon Derose's NPI number?

The NPI number for Shannon Derose is 1407004898. It was assigned to this individual provider in the NPPES registry on August 28, 2008. The provider is also known as Shannon Parker.

Where is Shannon Derose located?

Shannon Derose practices at 125 Red Creek Dr Ste 205, Rochester, NY 14623. The listed phone number is (585) 723-7600.

What is Shannon Derose's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

Is Shannon Derose enrolled in Medicare?

Yes. Shannon Derose 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.

Is Shannon Derose affiliated with any hospitals?

According to CMS data, Shannon Derose is affiliated with Rochester General Hospital.

When was this NPI record last updated?

The NPPES record for Shannon Derose was last updated on September 14, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.