SHANNON MARIE STOLL (PAC) – Surgical Physician Assistant, NPI 1144896879
Surgical Physician Assistant
Main info
Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
2,876 PHYSICIAN ASSISTANT in OR
Provider Addresses for SHANNON MARIE STOLL (PAC)
11000 SW Stratus St Ste 205
Beaverton, OR 970087104
Phone: (503) 281-0561
Fax: (503) 416-7377
Type: Location
541 NE 20TH AVE STE 225
PORTLAND, OR 972322895
Phone: (503) 963-2801
Fax: (503) 963-2825
Type: Mailing
847 NE 19TH AVE STE 300
PORTLAND, OR 972322686
Phone: (503) 963-2801
Fax: (503) 963-2825
Type: Mailing
4805 NE GLISAN ST # 6N60
PORTLAND, OR 972132933
Phone: (503) 281-0561
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-01-23
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20210805001245 | I | Physician Assistant | OR | TBD |
| I20240123001556 | I | Physician Assistant | WA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 97008)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Pulmonary Disease | OR | |
| - | OR | |
| O T O L A R Y N G O L O G Y | OR | |
| Internal Medicine, Gastroenterology | OR | |
| Gastroenterology, Internal Medicine | OR | |
| - | OR | |
| - | OR | |
| Qualified Audiologist | OR | |
| N E U R O S U R G E R Y | OR | |
| General Surgery | OH |
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