SHANNON TISDELL FNP
NPI 1790384329
Nurse Practitioner - Family in Olive Branch, MS
About Shannon Tisdell Fnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SHANNON TISDELL FNP (NPI 1790384329) is an individual family provider in Olive Branch, Mississippi, licensed in Mississippi (904149) and active in the NPI registry since October 2020. She is enrolled in Medicare PECOS, is affiliated with Regional One Health, and is a graduate of Other (2020).
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Shannon Tisdell Fnp 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.
Medicare Billing Reassignments
2Medicare enrollment records show Shannon Tisdell reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Memphis, TN 38103
- Reassigned Medicare billing, Tennessee enrollment
- 421 clinicians in this Medicare group
Pontotoc, MS 38863
- Reassigned Medicare billing, Mississippi enrollment
- 118 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Regional One Health
Acute Care Hospitals · Memphis, TNPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 38654 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
Other Providers at the Same Location NPPES 3
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Tisdell's NPI number?
The NPI number for Shannon Tisdell is 1790384329. It was assigned to this individual provider in the NPPES registry on October 24, 2020.
Where is Shannon Tisdell located?
Shannon Tisdell practices at 6674 Goodman Rd, Olive Branch, MS 38654. The listed phone number is (662) 985-7806.
What is Shannon Tisdell's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Shannon Tisdell enrolled in Medicare?
Yes. Shannon Tisdell 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.
Which organizations bill Medicare for Shannon Tisdell's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Shannon Tisdell reassigns Medicare benefits to 2 organizations: Ut Regional One Physicians Inc (Memphis, TN) and Redmed, LLC (Pontotoc, MS). 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 Tisdell's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Shannon Tisdell accept?
Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter of Alabama and Ambetter of Tennessee and 2 other insurers list Shannon Tisdell as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
Is Shannon Tisdell affiliated with any hospitals?
According to CMS data, Shannon Tisdell is affiliated with Regional One Health.
When was this NPI record last updated?
The NPPES record for Shannon Tisdell was last updated on October 24, 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.
# Shannon Tisdell, FNP · NPI 1790384329
Family physician in Olive Branch, Mississippi. Individual provider, active in the CMS NPPES registry since October 24, 2020.
## Identity
- **NPI:** 1790384329 (Entity type: Individual)
- **Enumerated:** October 24, 2020
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** 904149 (Mississippi)
- **Sole proprietor:** No
## Practice location
- **Address:** 6674 GOODMAN RD, Olive Branch, MS 38654-7056
- **Phone:** (662) 985-7806
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Ut Regional One Physicians Inc (NPI 1093130585, Memphis, TN); Redmed, LLC (NPI 1437589157, Pontotoc, MS) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2020
## Record status
- **NPPES last updated:** October 24, 2020
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Source: [NPI Profile](https://npiprofile.com/npi/1790384329) · Data from the CMS NPPES public registry.