Shannon M Goddard, PA is a medicare enrolled "Physician Assistant - Medical" in Lemon Grove, California. She graduated from nursing school in 2011 and has 13 years of diverse experience with area of expertise as Physician Assistant. She is a member of the group practice Kaiser Foundation Health Plan Of The Northwest and her current practice location is
7592 Broadway, Lemon Grove, California. You can reach out to her office (for appointments etc.) via phone at
(619) 515-2300.
Shannon M Goddard is licensed to practice in California (license number 56072) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1780961417.
Provider's Profile
| Full Name | Shannon M Goddard |
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| Gender | Female |
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| Speciality | Physician Assistant |
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| Experience | 13 Years |
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| Location | 7592 Broadway, Lemon Grove, California |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Shannon M Goddard graduated from nursing school in 2011
NPI Data:
- NPI Number: 1780961417
- Provider Enumeration Date: 11/09/2011
- Last Update Date: 03/25/2020
Medicare PECOS Information:
- PECOS PAC ID: 2365672896
- Enrollment ID: I20220630002489
Medical Identifiers
Medical identifiers for Shannon M Goddard such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1780961417 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363A00000X | Physician Assistant | 3347 (Colorado) | Secondary |
| 363AM0700X | Physician Assistant - Medical | 56072 (California) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Kaiser Foundation Health Plan Of The Northwest | 5799688230 | 1484 |
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. Shannon M Goddard 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 |
|---|
Shannon M Goddard, PA
Po Box 158,
Espanola, NM 87532-0158
Ph: (505) 753-7218 | Shannon M Goddard, PA
7592 Broadway,
Lemon Grove, CA 91945-1604
Ph: (619) 515-2300 |
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