SHANNON CLINIC
NPI 1770587149
Family Medicine in San Angelo, TX

NPI Status: Active since June 13, 2005

Contact Information

120 E BEAUREGARD AVE
SAN ANGELO, TX
ZIP 76903
Phone: (325) 658-1511
Fax: (325) 481-2166

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  • Organization
  • Family Medicine
  • Accepts Insurance
  • Medicare Supplier
  • Accepts Medicare Approved Payment
  • CLIA Number: 45D2150292
  • CLIA Cert. Type: Physician Office
  • CLIA Exp. Date: 06-20-2026

About SHANNON CLINIC

This page provides the complete NPI Profile along with additional information for Shannon Clinic, a primary care provider established in San Angelo, Texas operating as a Family Medicine. The healthcare provider is registered in the NPI registry with number 1770587149 assigned on June 2005. The practitioner's primary taxonomy code is 207Q00000X. The provider is registered as an organization and their NPI record was last updated one year ago. Shannon Clinic operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The authorized official of this NPI record is Ricardo Villarreal (Coo)

NPI
1770587149
Provider Name
SHANNON CLINIC
Entity Type
Organization
Location Address
120 E BEAUREGARD AVE SAN ANGELO, TX 76903
Location Phone
(325) 658-1511
Location Fax
(325) 481-2166
Mailing Address
PO BOX 22000 SAN ANGELO, TX 76902
Mailing Phone
(325) 658-1511
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
06-13-2005
Last Update Date
07-14-2025
Code Navigator

A primary care provider (PCP) like Shannon Clinic sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .

Shannon Clinic is a medicare supplier with PTAN 20668205 who accepts Medicare assignment for all durable medical equipment and supplies. The provider accepts the Medicare allowable as payment in full.The supplier carries the following product categories: Epoetin or Immunosuppressive Drugs or Infusion Drugs or Nebulizer Drugs or Oral Anticancer Drugs or Oral Antiemetic Drugs or Contracture Treatment Devices: Dynamic Splint or Negative Pressure Wound Therapy Pumps/Supplies or Neuromuscular Elect Stimulators (NMES)/Supplies or Pneumatic Compression Devices and/or Supplies or (TENS) Transcutaneous Electrical Nerve Stimulators and/or Supplies or Canes and/or Crutches or Walkers or Orthoses: Custom Fabricated or Orthoses: Prefabricated (Non-Custom Fabricated) or Orthoses: Off-The-Shelf or Penile Pumps or Neurostimulators and/or Supplies or Ostomy Supplies or Tracheotomy Supplies or Urological Supplies or Prosthetic Lenses: Prosthetics Cataract Lenses or Enteral Nutrients or Enteral Equipment and/or Supplies or Parenteral Nutrients or Parenteral Equipment and/or Supplies or Continuous Positive Airway Pressure (CPAP) Devices or Nebulizer Equipment and/or Supplies or Surgical Dressings or Diabetic Shoes and Inserts or Diabetic Shoes/Inserts - Custom.

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Family Medicine

Taxonomy Code
207Q00000X
Type
Allopathic & Osteopathic Physicians
License State
TX
Taxonomy Description
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No. Taxonomy Code Type Classification /
Specialization
License No. (State)
1207K00000XAllopathic & Osteopathic Physicians

Allergy & Immunology

(TX)
2207KA0200XAllopathic & Osteopathic Physicians

Allergy & Immunology
Allergy

(TX)
3207L00000XAllopathic & Osteopathic Physicians

Anesthesiology

(TX)
4207N00000XAllopathic & Osteopathic Physicians

Dermatology

(TX)
5207R00000XAllopathic & Osteopathic Physicians

Internal Medicine

(TX)
6207T00000XAllopathic & Osteopathic Physicians

Neurological Surgery

(TX)
7207V00000XAllopathic & Osteopathic Physicians

Obstetrics & Gynecology

(TX)
8207W00000XAllopathic & Osteopathic Physicians

Ophthalmology

(TX)
9207X00000XAllopathic & Osteopathic Physicians

Orthopaedic Surgery

(TX)
10207Y00000XAllopathic & Osteopathic Physicians

Otolaryngology

(TX)
11207ZB0001XAllopathic & Osteopathic Physicians

Pathology
Blood Banking & Transfusion Medicine

(TX)
12208000000XAllopathic & Osteopathic Physicians

Pediatrics

(TX)
132085R0202XAllopathic & Osteopathic Physicians

Radiology
Diagnostic Radiology

(TX)
14208600000XAllopathic & Osteopathic Physicians

Surgery

(TX)

Group Taxonomy 193200000X MULTI-SPECIALTY GROUP

This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

  • Choice Bronze HSA - HMO
  • Choice Bronze HSA + Vision + Adult Dental - HMO
  • Complete Gold - HMO
  • Complete Gold + Vision + Adult Dental - HMO
  • Complete Silver - HMO
  • Complete Silver + Vision + Adult Dental - HMO
  • Elite Gold - HMO
  • Elite Gold + Vision + Adult Dental - HMO
  • Everyday Bronze - HMO
  • Everyday Bronze + Vision + Adult Dental - HMO
  • Choice Bronze HSA (QualChoice) - POS
  • Complete Gold - PPO
  • Complete Gold + Vision + Adult Dental - PPO
  • Connected Silver - PPO
  • Connected Silver (QualChoice) - POS
  • Connected Silver (QualChoice) + Vision + Adult Dental - POS
  • Connected Silver (QualChoiceLife) - PPO
  • Connected Silver (QualChoiceLife) + Vision + Adult Dental - PPO
  • Connected Silver + Vision + Adult Dental - PPO
  • Elite Bronze - PPO
  • Complete Gold - EPO
  • Complete Gold + Vision + Adult Dental - EPO
  • Elite Bronze - EPO
  • Elite Bronze + Vision + Adult Dental - EPO
  • Elite Gold - EPO
  • Elite Gold + Vision + Adult Dental - EPO
  • Everyday Bronze - EPO
  • Everyday Bronze + Vision + Adult Dental - EPO
  • Focused Silver - EPO
  • Focused Silver + Vision + Adult Dental - EPO
  • Complete Gold - EPO
  • Complete Gold + Vision + Adult Dental - EPO
  • Enhanced Diabetes Care Silver with $0 Drug Options - EPO
  • Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - EPO
  • Everyday Gold - EPO
  • Everyday Gold + Vision + Adult Dental - EPO
  • Focused Silver - EPO
  • Focused Silver + Vision + Adult Dental - EPO
  • Standard Gold - EPO
  • Standard Gold + Vision + Adult Dental - EPO
  • Elite Bronze - PPO
  • Elite Bronze + Vision + Adult Dental - PPO
  • Elite Gold - PPO
  • Elite Gold + Vision + Adult Dental - PPO
  • Enhanced Asthma/COPD Care Silver with $0 Drug Options - PPO
  • Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental - PPO
  • Enhanced Diabetes Care Silver with $0 Drug Options - PPO
  • Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - PPO
  • Everyday Bronze - PPO
  • Everyday Bronze + Vision + Adult Dental - PPO
  • Blue Advantage Bronze HMO? 204 - HMO
  • Blue Advantage Bronze HMO? 301 - HMO
  • Blue Advantage Bronze HMO? Standard - HMO
  • Blue Advantage Gold HMO? 206 - HMO
  • Blue Advantage Gold HMO? 603 - HMO
  • Blue Advantage Gold HMO? Standard - HMO
  • Blue Advantage Plus Bronze? 303 - POS
  • Blue Advantage Plus Bronze? 305 - POS
  • Blue Advantage Plus Bronze? Standard - POS
  • Blue Advantage Plus Gold? 203 - POS

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

RICARDO VILLARREAL

Authorized Official Title
COO
Authorized Official Phone
(325) 747-2200

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
00T83ZOTHER (01)TXMEDICARE
127005002OTHER (01)TXCSHCN
CL8387OTHER (01)TXMEDICARE PTAN
127005001MEDICAID (05)TX 

Medical Equipment Supplier

The provider carries the following medical supplies product categories:

PTAN
20668205
Accepts Medicare Assignment
YES
Specialities List
Orthotic Personnel.
Provider Type List
INDEPENDENTLY-PRACTICING PHYSICAL THERAPIST, MULTI-SPECIALTY - PHYSICIAN.
Competitive Bidding
NO

Supplies List

  • Epoetin - Epoetin is a man-made version of human erythropoietin (EPO)
  • Immunosuppressive Drugs - Immunosuppressive drugs require dosage, frequency, and route of administration to prevent or treat the rejection of an organ transplant
  • Infusion Drugs -
  • Nebulizer Drugs - Albuterol, levalbuterol, and metaproterenol are all short-acting bronchodilators with beta-adrenergic stimulatory effect
  • Oral Anticancer Drugs - FDA anticancer drugs
  • Oral Antiemetic Drugs - FDA antiemetic drugs
  • Contracture Treatment Devices: Dynamic Splint - Dynamic splinting devices for the knee, elbow, wrist, finger, or toe
  • Negative Pressure Wound Therapy Pumps/Supplies - Wound care sets, Pumps, Canisters
  • Neuromuscular Elect Stimulators (NMES)/Supplies - Electrodes, lead wires, adhesive tape
  • Pneumatic Compression Devices and/or Supplies - Pnuematic compressor, Arm pneumatic appliance, Leg pneumatic appliance
  • (TENS) Transcutaneous Electrical Nerve Stimulators and/or Supplies - Transcutaneous Electrical Nerve Stimulation (TENS) for the relief of acute post-operative pain
  • Canes and/or Crutches - Standard Canes, Quad Canes, Offset Canes, Standard Crutches, Forearm Crutches
  • Walkers - Standard Walkers, Wheeled Walkers, Folding Walker
  • Orthoses: Custom Fabricated - Custom met pads, Custom heel pads, Custom heel spur pads
  • Orthoses: Prefabricated (Non-Custom Fabricated) - Met pads, Heel pads, Heel spur pads
  • Orthoses: Off-The-Shelf - Met pads, Heel pads, Heel spur pads
  • Penile Pumps -
  • Neurostimulators and/or Supplies - Rechargable neurostimulators, Non-rechargable neurostimulators
  • Ostomy Supplies - Pouches, Paste, Powder, Barrier wipes
  • Tracheotomy Supplies - Tracheostomy care kits
  • Urological Supplies - Catheters, Urinary collection devices
  • Prosthetic Lenses: Prosthetics Cataract Lenses - Cataract Eyeglasses
  • Enteral Nutrients - Enteral formula
  • Enteral Equipment and/or Supplies - Enteral infusion pumps, enteral nutrition supply kits
  • Parenteral Nutrients - Parenteral nutrient solutions
  • Parenteral Equipment and/or Supplies - Parenteral infusion pumps, parenteral nutrition supply kits
  • Continuous Positive Airway Pressure (CPAP) Devices - CPAP machines, Compressor systems, Humidifiers, Masks
  • Nebulizer Equipment and/or Supplies - Nebulizers, Atomizers, Filters
  • Surgical Dressings - Gauze, Elastic bandages, Adhesive tape
  • Diabetic Shoes and Inserts - Shoes, Socks, Insoles
  • Diabetic Shoes/Inserts - Custom - Custom fabricated shoes, socks, & insoles

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
45D2150292
Facility Type
Physician Office
Certificate Effective Date
June 21, 2024
Certificate Expiration Date
June 20, 2026
Laboratory Director
ANDEREW P. KING
Certificate Type
Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description
This CLIA certificate is issued to Shannon Clinic in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.

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NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1770587149, we treat the final digit (9) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 61. The final step is to find the difference between that total and the next multiple of ten (70 - 61 = 9).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1
1
Doubled → 2
Pos 2
7
Unchanged
Pos 3
7
Doubled → 14 → 1 + 4
Pos 4
0
Unchanged
Pos 5
5
Doubled → 10 → 1 + 0
Pos 6
8
Unchanged
Pos 7
7
Doubled → 14 → 1 + 4
Pos 8
1
Unchanged
Pos 9
4
Doubled → 8
Check
9
Target digit
Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 7 → 14 → 5 5 → 10 → 1 7 → 14 → 5 4 → 8

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 7 + 1 + 4 + 0 + 1 + 0 + 8 + 1 + 4 + 1 + 8 + 24 = 61

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 61 is 70. The difference is the calculated check digit.

70 - 61 = 9
This NPI is valid
The calculated check digit is 9, which matches the last digit of 1770587149.

Other Providers at the Same Location


The following 20 providers are registered at the same or a nearby location.

Allergy & Immunology (Allergy)
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903
Internal Medicine
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903
Internal Medicine
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903
Internal Medicine
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903
Internal Medicine
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903
Anesthesiology
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903
Anesthesiology
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903
Anesthesiology
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903
Anesthesiology
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903
Anesthesiology
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903
Anesthesiology
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903
Internal Medicine
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903
Anesthesiology
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903
Internal Medicine (Gastroenterology)
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903
Neurological Surgery
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903
Obstetrics & Gynecology (Gynecology)
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903
Surgery
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903
Neurological Surgery
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903
Obstetrics & Gynecology
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903
Radiology (Diagnostic Radiology)
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1770587149, enumerated as an "organization" on June 13, 2005.

The provider is located at 120 E BEAUREGARD AVE SAN ANGELO, TX 76903 and the phone number is (325) 658-1511.

Family Medicine with taxonomy code 207Q00000X.

The provider might be accepting Accepts: Ambetter from Arizona Complete Health, Ambetter. Please consult your insurance carrier or call the provider to verify.