Individual ProviderShannon LoftisPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address1155 N Mayfair Rd, Plank Road Clinic, Milwaukee, WI 53226-3421(414) 955-5990PECOS EnrollmentBased on the most recent information from CMS, provider Shannon Loftis is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1972557221Provider TypeIndividualFull NameLoftis, ShannonTitleMs.CredentialPACGenderFemaleSole ProprietorNoEnumeration Date5/20/2006Last Updated8/21/2014Contact InformationPractice LocationPractice Address1155 N Mayfair Rd, Plank Road Clinic, Milwaukee, WI 53226-3421Phone(414) 955-5990Fax(414) 955-6282Mailing LocationMailing Address1155 N Mayfair Rd, Plank Road Clinic, Milwaukee, WI 53226-3421Phone(414) 955-5990Fax(414) 955-6282Provider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense928-023WisconsinProvider IdentifiersIDDescriptionIssuerID1972557221DescriptionMedicaidIssuerUnlistedWisconsinID008000315QDescriptionOtherIssuerHUMANA