MS. SHANNON DRE CHISHOLM PA-C
NPI 1700824638
Physician Assistant in Daytona Beach, FL

Q: What is Shannon Chisholm's NPI number?

The NPI number for Shannon Chisholm is 1700824638. It was assigned to this individual provider in the NPPES registry on June 3, 2006.

Q: What is Shannon Chisholm'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 Shannon Chisholm was last updated on October 3, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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 June 03, 2006PECOS EnrolledAccepts Medicare Assignment

595 N WILLIAMSON BLVD, DAYTONA BEACH, FL 32114(872) 231-3162(702) 977-1496 Get Directions Write a Review

NPPES record last updated: October 3, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Ms. Shannon Dre Chisholm Pa-c NPPES

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

MS. SHANNON DRE CHISHOLM PA-C (NPI 1700824638) is an individual physician assistant in Daytona Beach, Florida, licensed in Florida (PA9107966) and active in the NPI registry since June 2006. She is enrolled in Medicare PECOS and is a graduate of Other (1999).

NPPES Registry Identity

NPI1700824638

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameMS. SHANNON DRE CHISHOLMCredential: PA-C

Location Address595 N WILLIAMSON BLVDDaytona Beach, FL 32114-7185

Mailing AddressPo Box 7410884Chicago, IL 60674-0884 · (702) 899-0595 · Fax (702) 977-1496

Phone(872) 231-3162

Fax(702) 977-1496

Sole ProprietorYes

Medical School CMSOtherGraduated 1999

Enumeration DateJune 3, 2006

Last NPPES UpdateOctober 3, 2025

NPPES CertifiedOctober 3, 2025

✔ NPI 1700824638 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in FL · PA9107966

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.

Also ListedPhysician Assistant · SurgicalTaxonomy 363AS0400X · License PA02625 (TX)

595 N WILLIAMSON BLVD, Daytona Beach, FL 32114

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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

Ms. Shannon Dre Chisholm 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 ID1658431747

PECOS Enrollment IDI20151020000337

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.

Areas of Expertise CMS Part B claims

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.

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232

Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.

139 services95 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 32114 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

$87.62 typical visit price

range $56.00 – $171.84

Typical copayment $21.90 (range $14.00 – $42.96)

Most-billed visit code 99203

Established Patient

$70.04 typical visit price

range $17.57 – $139.16

Typical copayment $17.51 (range $4.39 – $34.79)

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.

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Other Providers at the Same Location NPPES 9

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

BEDROCK HCS AT DAYTONA FL LLC

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