Individual provider Active NPI

Alejandra C Ayestaran Cassani, MD

  • Pediatrics Physician
  • San Angelo, TX
National Provider Identifier
1003121245
Registry record updated Oct 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
N7213 Issued in TX
Practice address
2141 Hamilton Way
Ste 100
San Angelo, TX 76904-6831
Phone
(325) 245-4301
Fax
(325) 245-4034
NPI assigned
Aug 12, 2010
Last updated
Oct 31, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X N7213 TX Primary

Addresses

Primary practice location

2141 Hamilton Way
Ste 100
San Angelo, TX 76904-6831

Mailing address

2141 Hamilton Way
Ste 100
San Angelo, TX 76904-6831
Phone (325) 245-4301

Other identifiers 1

IdentifierTypeStateIssuer
283015001MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101117000594 TX Practitioner - Pediatric Medicine 7517152457 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Regional Employee Assistance Program Inc CurrentSince Aug 16, 2010 Accepting new patients
Regional Employee Assistance Program Inc Pediatrics Current Accepting new patients
Regional Employee Assistance Program Inc CurrentSince Aug 16, 2010 Accepting new patients
Shannon Clinic Pediatrics CurrentSince Oct 4, 2020 Accepting new patients
Magella Medical Associates Billing, Inc. Past Accepting new patients
Shannon Medical Center Past Accepting new patients

Locations

120 E Beauregard Ave
San Angelo, TX 76903
Phone (915) 658-1511

2141 Hamilton Way
Ste 100
San Angelo, TX 76904
Phone (325) 947-6472

2141 Hamilton Way
Ste 106
San Angelo, TX 76904
Phone (325) 245-4511

3501 Knickerbocker Rd
San Angelo, TX 76904
Phone (325) 947-6361

Interoperability endpoints

  • Direct secure messaging: aayestaran38923@shannonhealth.direct-ci.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1281571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320019200000",
    "number": "1003121245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2141 HAMILTON WAY",
            "address_2": "STE 100",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769046831",
            "telephone_number": "325-245-4301",
            "fax_number": "325-245-4034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2141 HAMILTON WAY",
            "address_2": "STE 100",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769046831",
            "telephone_number": "325-245-4301",
            "fax_number": "325-245-4034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AYESTARAN CASSANI",
        "first_name": "ALEJANDRA",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-12",
        "last_updated": "2011-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "N7213",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "283015001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Angelo, TX

Sources for this page

Verify at the official NPI Registry.