Shannon N Sandstrom, NP is a medicare enrolled "Nurse Practitioner - Adult Health" in Randolph, Wisconsin. Her current practice location is
137 Cambria St, Randolph, Wisconsin. You can reach out to her office (for appointments etc.) via phone at
(920) 326-5303.
Shannon N Sandstrom is licensed to practice in Wisconsin (license number 2722) 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 1194778324.
Provider's Profile
| Full Name | Shannon N Sandstrom |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Adult Health |
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| Location | 137 Cambria St, Randolph, Wisconsin |
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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: 1194778324
- Provider Enumeration Date: 05/18/2006
- Last Update Date: 07/08/2007
Medicare PECOS Information:
- PECOS PAC ID: 6103837596
- Enrollment ID: I20060524000006
Medical Identifiers
Medical identifiers for Shannon N Sandstrom such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1194778324 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363LA2200X | Nurse Practitioner - Adult Health | 2722 (Wisconsin) | 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. Shannon N Sandstrom allows following entities to bill medicare on her behalf.
| Entity Name | State Of Wisconsin |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1437253648
PECOS PAC ID: 9234181751
Enrollment ID: O20050214000153 |
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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. Shannon N Sandstrom 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 N Sandstrom, NP
420 E Division St,
Fond Du Lac, WI 54935-4560
Ph: (920) 926-8340 | Shannon N Sandstrom, NP
137 Cambria St,
Randolph, WI 53956
Ph: (920) 326-5303 |
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