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DR. JACKY DWAYNE SHANNON M.D. NPI 1265510218


NPI Information

NPI: 1265510218
Provider Name: DR. JACKY DWAYNE SHANNON, M.D.
Classification: Anesthesiology - 207LC0200X
Entity Type: Individual

Specialization: Critical Care Medicine

Organization: NORTHSTAR ANESTHESIA PA

PECOS Registration: Yes

Address:
3601 4TH ST
LUBBOCK, TX
ZIP 79430
Phone: (806) 743-2981
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DR. Jacky Dwayne Shannon, M.D. is a critical care medicine anesthesiology in Lubbock, TX with 22 years of experience. The provider is an anesthesiologist, who specializes in critical care medicine diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff and other specialists. DR. Jacky Dwayne Shannon, M.D. NPI is 1265510218. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: TEXAS TECH UNIVERSITY HEALTH SCIENCE CENTER SCHOOL OF MEDICINE
Graduation Year:2002

The provider's business location address is:

3601 4TH ST
LUBBOCK, TX
ZIP 79430-002
Phone: (806) 743-2981

The NPI 1265510218 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Insertion of arterial catheter for blood sampling or infusion, accessed through the skin (HCPCS:36620)
  • Insertion of central venous catheter for infusion, patient 5 years or older (HCPCS:36556)

The enumeration date for this NPI number is 11/1/2006 and was last updated on 11/30/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207L00000XAnesthesiologyL8505TEXASNo
2207LC0200XAnesthesiologyCritical Care MedicineL8505TEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1L8505OTHERTEXASMEDICAL LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.