CMS-1500 Box 24J / 33a • NPI
1477057883
Type 1 Individual Rendering/Ordering
HIPAA NUCC Taxonomy • CMS Code
207P00000X (CMS 93)
Board-Certified Emergency Medicine Physician (ER / Trauma Doctor)
Box 32 Service Location & ZIP+4
401 MATTHEW ST, MARIETTA, OH, 45750-1635
✓ 9-Digit EDI 837 ZIP+4 (45750-1635)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1477057883 (SHANNON ALTAZAN, DO) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Medicare Part B
✓ Eligible
DMEPOS Ordering
✓ Eligible
Home Health (HHA)
✓ Eligible
Power Mobility
✓ Eligible
Hospice Referring
✓ Eligible
Empirical CMS Medicare Claims, CPT Utilization & Part D Prescribing (NPI #1477057883)
Medicare Beneficiaries
432
Total Billed Services
547
Distinct CPT/HCPCS Codes
20
Medicare Allowed Total
$75,193.85
Actual Top Billed CPT / HCPCS Procedures (CMS Part B)
| CPT / HCPCS | Clinical Procedure Description | Services |
|---|---|---|
93010 | Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only | 54 |
99283 | Emergency department visit with low level of medical decision making | 28 |
99284 | Emergency department visit with moderate level of medical decision making | 112 |
99285 | Emergency department visit with high level of medical decision making | 304 |
99291 | Critical care, first 30-74 minutes | 13 |
Actual Top Prescribed Medications (CMS Part D)
| Brand / Generic Medication | Total Claims | Patients |
|---|---|---|
| Amoxicillin-Clavulanate Potass Amoxicillin/Potassium Clav | 14 | 14 |
| Azithromycin Azithromycin | 26 | 26 |
| Cephalexin Cephalexin | 48 | 48 |
| Hydrocodone-Acetaminophen Hydrocodone/Acetaminophen | 48 | 44 |
| Levofloxacin Levofloxacin | 13 | 13 |
| Methocarbamol Methocarbamol | 27 | 27 |
| Ondansetron Odt Ondansetron | 36 | 35 |
| Prednisone Prednisone | 95 | 94 |
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1477057883 (NPI-1 Individual Practitioner) |
|---|---|
| Provider / Legal Name | SHANNON ALTAZAN, DO |
| Plain-English Specialty | Board-Certified Emergency Medicine Physician (ER / Trauma Doctor) NUCC Code: 207P00000X (Emergency Medicine) |
| Certifying / Licensing Body | American Board of Emergency Medicine (ABEM) |
| Practice Location Address | 401 MATTHEW ST, MARIETTA, OH, 45750-1635 |
| Practice Telephone / Fax | Tel: (740) 376-1939 | Fax: (740) 374-1693 |
| Administrative Mailing Address | 1467 TORNES RD, LOWELL, OH, 45744-7187 |
| Enumeration & Last Sync | Enumerated: 2018-03-20 | CMS Record Updated: 2026-10-26 |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (207P00000X)
What Does Taxonomy Code 207P00000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 207P00000X translates to:
"Board-Certified Emergency Medicine Physician (ER / Trauma Doctor)"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (SHANNON ALTAZAN, DO)
Typical CPT / Diagnostic Procedures:- Level 4 & Level 5 Emergency Department Resuscitation (CPT 99284–99285)
- Point-of-Care Emergency Ultrasound (eFAST), Intubation & Central Line Placement
- Acute Laceration Repair, Tetanus Prophylaxis & Fracture Splinting
- Epinephrine Auto-Injectors / IV Infusions, Atropine & Amiodarone
- Tetanus Toxoid / Tdap & Tetanus Immunoglobulin (TIG)
- Empiric Sepsis Antibiotics, Parenteral Ketorolac & Ondansetron
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
207P00000X — Emergency MedicinePlain English: Board-Certified Emergency Medicine Physician (ER / Trauma Doctor) | State: OH | License: 34.015793 | Primary: Yes (Primary) |
207P00000X — Emergency MedicinePlain English: Board-Certified Emergency Medicine Physician (ER / Trauma Doctor) | State: WV | License: 3742 | Primary: Secondary |
207Q00000X — Family MedicinePlain English: Board-Certified Family Medicine Physician (All-Ages Primary Care Doctor) | State: OH | License: 34.015793 | Primary: Secondary |
Medical Billing, RCM & Hospital Credentialing Teams:
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