Individual provider Active NPI

Shanna Burris Meads, MD

  • Dermatology Physician
  • Tyler, TX
National Provider Identifier
1023054624
Registry record updated May 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
M0820 Issued in TX
Practice address
1367 Dominion PLZ
Tyler, TX 75703-1013
Phone
(903) 534-6200
NPI assigned
Jun 21, 2006
Last updated
May 22, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X M0820 TX Primary
MOHS-Micrographic Surgery Physician 207ND0101X M0820 TX

Addresses

Primary practice location

1367 Dominion PLZ
Tyler, TX 75703-1013

Mailing address

1367 Dominion PLZ
Tyler, TX 75703-1013

Other identifiers 3

IdentifierTypeStateIssuer
P00228994OtherTXRAILROAD MEDICARE PTAN
8A2684OtherTXBLUE CROSS AND BLUE SHIELD
173749601MedicaidTX

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
I20050422000869 TX Practitioner - Dermatology 2264470806 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Arkansas College of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Epiphany Dermatology PAGroup PAC ID 3971827791, 106 clinicians

Practice addresses (Care Compare)

2639 Elkton TRL
Tyler, TX 75703-0585
Phone (903) 509-2020

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.97 of 100Reported as group
Quality
76.91
Promoting interoperability
91
Improvement activities
40
Cost
77.16

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision163
Removal of skin lesions1132
Removal of skin cancer625
Skin biopsy583

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M0820TXMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Epiphany Dermatology PA Dermatology CurrentSince May 15, 2021 Accepting new patients
Oliver Street 5.01(a) Inc. Dermatology CurrentSince Dec 15, 2012 Accepting new patients
Lawrence L Anderson MD PA Dermatology Past Accepting new patients

Locations

6601 Vaught Ranch Rd
Ste 200
Austin, TX 78730
Phone (575) 640-6306

7300 Ranch Road 2222
Bldg 1
Austin, TX 78730

1367 Dominion Plz
Tyler, TX 75703
Phone (903) 534-6200

2639 Elkton Trl
Tyler, TX 75703
Phone (903) 509-2020

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211414400000",
    "number": "1023054624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1367 DOMINION PLZ",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1367 DOMINION PLZ",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031013",
            "telephone_number": "903-534-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEADS",
        "first_name": "SHANNA",
        "middle_name": "BURRIS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-21",
        "last_updated": "2008-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TX",
            "license": "M0820",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "TX",
            "license": "M0820",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN",
            "identifier": "P00228994",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND BLUE SHIELD",
            "identifier": "8A2684",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "173749601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.