Dr Shannon Elyse Stovall, LPC, PSYD is a medicare enrolled "Psychologist" provider in Fremont, California. Her current practice location is
39465 Paseo Padre Pkwy, Suite 2100, Fremont, California. You can reach out to her office (for appointments etc.) via phone at
(510) 745-9151.
Dr Shannon Elyse Stovall is licensed to practice in California (license number 26755) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1861705188.
Healthcare Provider's Profile
| Full Name | Dr Shannon Elyse Stovall |
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| Gender | Female |
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| Speciality | Psychologist |
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| Location | 39465 Paseo Padre Pkwy, Fremont, California |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1861705188
- Provider Enumeration Date: 07/15/2010
- Last Update Date: 01/03/2022
Medicare PECOS Information:
- PECOS PAC ID: 7810213246
- Enrollment ID: I20150303000684
Medical Identifiers
Medical identifiers for Dr Shannon Elyse Stovall such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1861705188 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YP2500X | Counselor - Professional | 64885 (Texas) | Secondary |
| 103TC1900X | Psychologist - Counseling | 26755 (California) | Secondary |
| 103T00000X | Psychologist | 26755 (California) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Shannon Elyse Stovall allows following entities to bill medicare on her behalf.
| Entity Name | Permanente Medical Group Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1073606299
PECOS PAC ID: 8921910225
Enrollment ID: O20031104000710 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Shannon Elyse Stovall is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Dr Shannon Elyse Stovall, LPC, PSYD
39465 Paseo Padre Pkwy, Suite 2100,
Fremont, CA 94538-5350
Ph: (210) 542-4616 | Dr Shannon Elyse Stovall, LPC, PSYD
39465 Paseo Padre Pkwy, Suite 2100,
Fremont, CA 94538-5350
Ph: (510) 745-9151 |
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