SHANNON LEE RUTH DIEFFENDERFER
NPI 1861048530
Physician Assistant in Anchorage, AK

Q: What is Shannon Dieffenderfer's NPI number?

The NPI number for Shannon Dieffenderfer is 1861048530. It was assigned to this individual provider in the NPPES registry on August 17, 2019.

Q: What is Shannon Dieffenderfer's specialty?

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

Active since August 17, 2019PECOS EnrolledAccepts Medicare Assignment

4100 LAKE OTIS PKWY STE 108, ANCHORAGE, AK 99508(907) 563-3145(907) 561-3967 Get Directions Write a Review

NPPES record last updated: June 6, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jun 6, 2022, May 12, 2021, Aug 27, 2020 and 1 more (4 updates tracked since 2019).

On this page

About Shannon Lee Ruth Dieffenderfer NPPES

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

SHANNON LEE RUTH DIEFFENDERFER (NPI 1861048530) is an individual physician assistant in Anchorage, Alaska, licensed in Alaska (172156) and active in the NPI registry since August 2019. She is enrolled in Medicare PECOS, maintains a secondary practice location in Glennallen, and is a graduate of Philadelphia Col Of Osteo Med, Sewanee (2020).

NPPES Registry Identity

NPI1861048530

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameSHANNON LEE RUTH DIEFFENDERFER

Location Address4100 LAKE OTIS PKWY STE 108Anchorage, AK 99508-5230

Mailing Address4100 Lake Otis Pkwy Ste 108Anchorage, AK 99508-5230 · (907) 563-3145 · Fax (907) 561-3967

Phone(907) 563-3145

Fax(907) 561-3967

Sole ProprietorYes

Medical School CMSPhiladelphia Col Of Osteo Med, SewaneeGraduated 2020

Enumeration DateAugust 17, 2019

Last NPPES UpdateJune 6, 20224 updates tracked since enumeration

NPPES CertifiedJune 6, 2022

✔ NPI 1861048530 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

Licenses✔ Licensed in AK · 172156✔ Licensed in GA · 10117

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 ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

4100 LAKE OTIS PKWY STE 108, Anchorage, AK 99508

Open in Google Maps ↗

Secondary Practice Location 1

Location 1187 Glenn HwyGlennallen, AK 99588-0005 · Phone (907) 822-5686

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc., Premera Blue Cross Blue Shield of Alaska, Providence Health Plan.Insurance ›

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 Lee Ruth Dieffenderfer 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 ID9032526272

PECOS Enrollment IDI20210505003147

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 3

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.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

181 services136 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

63 services60 patients

Aspiration and/or injection of fluid from large joint 20610

This procedure involves using a needle to remove (aspiration) or introduce (injection) fluid into a large joint like the knee or hip. It can help diagnose conditions, relieve discomfort, or deliver medication directly to the joint.

16 services15 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 99508 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

$111.57 typical visit price

range $71.33 – $222.64

Typical copayment $27.89 (range $17.83 – $55.66)

Most-billed visit code 99203

Established Patient

$90.40 typical visit price

range $21.84 – $181.48

Typical copayment $22.60 (range $5.46 – $45.37)

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.

Leave this field empty

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.

JARED ROBERT KIRKHAM M.D.

Physical Medicine & Rehabilitation (Sports Medicine)