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SHANNON BOLDENOW
NPI 1720628357
Nurse Anesthetist, Certified Registered in Pontiac, MI

Active since January 12, 2020
83.28/100
CMS Quality Rating
44405 WOODWARD AVE, PONTIAC, MI 48341(248) 858-3000 Get Directions Write a Review

NPPES record last updated: January 12, 2020. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Shannon Boldenow NPPES

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

SHANNON BOLDENOW (NPI 1720628357) is an individual nurse anesthetist, certified registered in Pontiac, Michigan, licensed in Michigan (4704283091) and active in the NPI registry since January 2020. She is affiliated with Beaumont Hospital, Troy and is a graduate of Other (2019).

NPPES Registry Identity

NPI1720628357
Entity TypeIndividualFemale
Primary Taxonomy367500000X
Provider Legal NameSHANNON BOLDENOW
Location Address44405 WOODWARD AVEPontiac, MI 48341-5023
Mailing Address4840 Alton CtTroy, MI 48085-5044
Phone(248) 858-3000
Sole ProprietorNo
Medical School CMSOtherGraduated 2019
Enumeration DateJanuary 12, 2020
✔ NPI 1720628357 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code367500000X
License✔ Licensed in MI · 4704283091
Definition
(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.
44405 WOODWARD AVE, Pontiac, MI 48341
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Shannon Boldenow is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID6507292703
PECOS Enrollment IDI20200206002735

Medicare Billing Reassignments

4

Medicare enrollment records show Shannon Boldenow reassigns Medicare billing to 4 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Northwestern Services, LLC
7.8 mi
Anesthesiology
30055 NORTHWESTERN HWY, SUITE L60
Farmington Hills, MI 48334
  • Reassigned Medicare billing, Michigan enrollment
  • 199 clinicians in this Medicare group
NPI 1083883649 (248) 865-6555
Axon Anesthesia Consultants, Plc
10 mi
Anesthesiology
1375 S LAPEER RD STE 109
Lake Orion, MI 48360
  • Reassigned Medicare billing, Michigan enrollment
  • 51 clinicians in this Medicare group
NPI 1235643495 (800) 222-1442
Nsa Pain Services Of Michigan III, PLLC
26 mi
Pain Medicine
10000 TELEGRAPH RD
Taylor, MI 48180
  • Reassigned Medicare billing, Michigan enrollment
  • 53 clinicians in this Medicare group
NPI 1376169524 (214) 687-0001
Northstar Anesthesia Of Michigan III PLLC
1,004 mi
Pain Medicine
6225 N STATE HIGHWAY 161 STE 200
Irving, TX 75038
  • Reassigned Medicare billing, Michigan enrollment
  • 905 clinicians in this Medicare group
NPI 1972126209 (214) 687-0001

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

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.

Anesthesia for other procedure on esophagus, stomach, or upper small bowel using an endoscope 00731
This procedure involves the use of an endoscope, a flexible tube with a light and camera, to examine your esophagus, stomach, or upper small bowel. Anesthesia ensures you are comfortable and pain-free during the procedure.
23 services23 patients

Hospital Affiliations CMS Care Compare

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

Beaumont Hospital, Troy

Acute Care Hospitals · Troy, MI
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number230269
Location44201 Dequindre RoadTroy, MI 48085 · Oakland 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.

83.28/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality86.98
Improvement Activities40
Cost68.13

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.

DR. KRASSIMIR LALEV DENCHEV M.D.
Anesthesiology (Critical Care Medicine)
44405 WOODWARD AVE
PONTIAC, MI 48341
Oakland County (248) 585-3023
ST. JOSEPH MERCY OAKLAND
General Acute Care Hospital
44405 WOODWARD AVE
PONTIAC, MI 48341
Oakland County (248) 858-3000
ALEXANDRA SAUNDERS CNM
Advanced Practice Midwife
44405 WOODWARD AVE
PONTIAC, MI 48341
Oakland County (248) 645-0840
LAURENCE ALEXANDER ROBERTS MD
Student in an Organized Health Care Education/Training Program
44405 WOODWARD AVE
PONTIAC, MI 48341
Oakland County (248) 858-3000
HAYLEY ELIZABETH MARCINKOWSKI
Internal Medicine (Critical Care Medicine)
44405 WOODWARD AVE
PONTIAC, MI 48341
Oakland County (248) 858-3000
DR. LAURA HARNESS DDS
Dentist
44405 WOODWARD AVE
PONTIAC, MI 48341
Oakland County (248) 858-6100
LEAH LIU
Surgery
44405 WOODWARD AVE
PONTIAC, MI 48341
Oakland County (248) 858-3000
DR. HENRY HUY KHANH NGUYEN M.D.
Radiology (Diagnostic Radiology)
44405 WOODWARD AVE
PONTIAC, MI 48341
Oakland County (248) 858-3266

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 Boldenow's NPI number?

The NPI number for Shannon Boldenow is 1720628357. It was assigned to this individual provider in the NPPES registry on January 12, 2020.

Where is Shannon Boldenow located?

Shannon Boldenow practices at 44405 Woodward Ave, Pontiac, MI 48341. The listed phone number is (248) 858-3000.

What is Shannon Boldenow's specialty?

The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.

Is Shannon Boldenow enrolled in Medicare?

Yes. Shannon Boldenow is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Shannon Boldenow's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Shannon Boldenow reassigns Medicare benefits to 4 organizations: Northwestern Services, LLC (Farmington Hills, MI), Axon Anesthesia Consultants, Plc (Lake Orion, MI), Nsa Pain Services Of Michigan III, PLLC (Taylor, MI) and Northstar Anesthesia Of Michigan III PLLC (Irving, TX). Each 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 Shannon Boldenow's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

Is Shannon Boldenow affiliated with any hospitals?

According to CMS data, Shannon Boldenow is affiliated with Beaumont Hospital, Troy.

When was this NPI record last updated?

The NPPES record for Shannon Boldenow was last updated on January 12, 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.