Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Kristopher Ryan Shannon, MD

Individual provider Emergency Medicine Physician · NPI 1063807022

Dr. Kristopher Ryan Shannon, MD is an Emergency Medicine in Pocatello, Idaho. Qualified in 2015, 11 years ago. Practices with Fremont Emergency Services Scherr Ltd, a 141-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Idaho, Nevada and Utah.

Years since qualifying
11
Licensed in
ID, NV, UT
In the registry since
2015
Specialties on file
4
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

850 Yellowstone Ave
Pocatello, ID 83201-4415
Phone: (208) 239-8065
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 98 Poplar St, Blackfoot, ID 83221-1799 — (208) 785-3813

Specialties & licences

Emergency Medicine Physician (primary) Taxonomy 207P00000X · Licence M-16351 (ID)
Emergency Medicine Physician Taxonomy 207P00000X · Licence 12009729-1205 (UT)
Emergency Medicine Physician Taxonomy 207P00000X · Licence 17765 (NV)
Urgent Care Clinic/Center Taxonomy 261QU0200X · Licence M-16351 (ID)

Record details

NPI number1063807022
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedApril 6, 2015
Last updated in NPPESOctober 17, 2025
Certification dateOctober 17, 2025
Mailing address98 Poplar St, Blackfoot, ID 83221-1799

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyEMERGENCY MEDICINE
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Fremont Emergency Services Scherr Ltd — 141 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

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