VISTA VERDE MEDICAL PLAZA
NPI 1790986719
Family Medicine in Del Rio, TX

NPI Status: Active since May 29, 2007

Contact Information

1801 N BEDELL AVE
DEL RIO, TX
ZIP 78840
Phone: (830) 768-9200

NPI Profile Information
Primary Taxonomy
Secondary Taxonomies
Group Taxonomy
Insurance Plans Accepted
Authorized Official
CLIA Information
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Organization
Family Medicine
Accepts Insurance
CLIA Number: 45D2094034
CLIA Cert. Type: Physician Office
CLIA Exp. Date: 04-07-2027

About VISTA VERDE MEDICAL PLAZA

This page provides the complete NPI Profile along with additional information for Vista Verde Medical Plaza, a primary care provider established in Del Rio, Texas operating as a Family Medicine. The healthcare provider is registered in the NPI registry with number 1790986719 assigned on May 2007. The practitioner's primary taxonomy code is 207Q00000X. The provider is registered as an organization and their NPI record was last updated 5 years ago. Vista Verde Medical Plaza operates as a multi-specialty business group with one or more individual providers who practice different areas of specialization. The provider's is doing business as Vista Verde Medical Plaza. The authorized official of this NPI record is Gary Bowen (Chief Operations Officer)

NPI: 1790986719
Provider Legal Name: SHANNON CLINIC
Other Organization Name: VISTA VERDE MEDICAL PLAZA
Other Name Type: Doing Business As (3)
Entity Type: Organization
Location Address: 1801 N BEDELL AVE DEL RIO, TX 78840
Location Phone: (830) 768-9200
Mailing Address: PO BOX 90201 SAN ANGELO, TX 76902
Mailing Phone: (325) 658-1511
Is Sole Proprietor?: No
Is Organization Subpart?: No
Enumeration Date: 05-29-2007
Last Update Date: 08-22-2020
Code Navigator

A primary care provider (PCP) like Vista Verde Medical Plaza 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 .

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
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)

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:

Blue Cross and Blue Shield of Texas

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
Blue Advantage Plus Gold? 803 - POS
Blue Advantage Plus Gold? Standard - POS
Blue Advantage Plus Silver? 202 - POS
Blue Advantage Plus Silver? 605 - POS
Blue Advantage Plus Silver? Standard - POS
Blue Advantage Security HMO? 200 - HMO
Blue Advantage Silver HMO? 205 - HMO
Blue Advantage Silver HMO? 801 - HMO
Blue Advantage Silver HMO? Standard - HMO

*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: GARY BOWEN
Authorized Official Title: CHIEF OPERATIONS OFFICER
Authorized Official Phone: (325) 658-1511

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: 45D2094034
Facility Type: Physician Office
Certificate Effective Date: April 08, 2025
Certificate Expiration Date: April 07, 2027
Laboratory Director: DR. MARK EDWARDS
Certificate Type: Certificate of Waiver
Certificate Type Description: This CLIA certificate is issued to Vista Verde Medical Plaza to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI Validation Check Digit Calculation

The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1	7	9	0	9	8	6	7	1	9
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2	7	18	0	18	8	12	7	2
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 7 + 1 + 8 + 0 + 1 + 8 + 8 + 1 + 2 + 7 + 2 + 24 = 71
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
80 - 71 = 9									9

The NPI number 1790986719 is valid because the calculated check digit 9 using the Luhn validation algorithm matches the last digit of the original NPI number.