SHANNON CLINIC – Family Medicine Physician, NPI 1770587149
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for SHANNON CLINIC
PO BOX 22000
SAN ANGELO, TX 769027200
Phone: (325) 658-1511
Type: Mailing
120, East Beauregard Avenue, Downtown, San Angelo, Tom Green County, Texas, 76903, United States
SAN ANGELO, TX 769035919
Phone: (325) 658-1511
Fax: (325) 481-2166
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-09-05
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 21 Medicare enrollment records; no due dates published yet.
Enrollment records
21
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20250425001347 | O | Clinic/Group Practice | HI | TBD |
| O20250428002854 | O | Clinic/Group Practice | NC | TBD |
| O20250502001328 | O | Clinic/Group Practice | VA | TBD |
| O20250502002163 | O | Clinic/Group Practice | SC | TBD |
| O20250505002056 | O | Clinic/Group Practice | OH | TBD |
| O20250506001259 | O | Clinic/Group Practice | MS | TBD |
| O20250506002354 | O | Clinic/Group Practice | CO | TBD |
| O20250506002515 | O | Clinic/Group Practice | WA | TBD |
| O20250506002757 | O | Clinic/Group Practice | NV | TBD |
| O20250506002871 | O | Clinic/Group Practice | OR | TBD |
| O20250506003222 | O | Clinic/Group Practice | MA | TBD |
| O20250507000297 | O | Clinic/Group Practice | MD | TBD |
| O20250507002678 | O | Clinic/Group Practice | PA | TBD |
| O20250520000628 | O | Clinic/Group Practice | ID | TBD |
| O20250521002277 | O | Clinic/Group Practice | KS | TBD |
| O20250526000047 | O | Clinic/Group Practice | FL | TBD |
| O20250527001831 | O | Clinic/Group Practice | CA | TBD |
| O20250528001709 | O | Clinic/Group Practice | IL | TBD |
| O20250530001537 | O | Clinic/Group Practice | GA | TBD |
| O20250612002586 | O | Clinic/Group Practice | MI | TBD |
| O20250905000622 | O | Clinic/Group Practice | UT | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 76902)
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