Shawn R Agenbroad-Elander, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP118041 Issued in TX

Practice address

4303 Victory Dr
Austin, TX 78704-7507

Phone

(512) 462-3627

Fax

(512) 462-2898

NPI assigned

Aug 25, 2009

Last updated

Jan 10, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Privia Medical Group Gulf Coast PLLCGroup PAC ID 4688999022, 511 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shawn.agenbroad-elander.1@8042.direct.athenahealth.com

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.

• Privia Medical Group Gulf Coast, PLLC

  • Obstetrics & Gynecology Physician
  • Houston, TX
  • NPI 1578969465
  Medicare reassignment Care Compare group NPD
• Privia Medical Group Gulf Coast PLLC

  dba Express Pain and Urgent Care

  • Interventional Pain Medicine Physician
  • San Antonio, TX
  • NPI 1457167033
  NPD
• Toth Enterprises, II PA

  dba Victory Medical Labortory

  • Clinical Medical Laboratory
  • Austin, TX
  • NPI 1205440435
  NPD
• Wimberley Valley Medical Center LP

  • Family Medicine Physician
  • Wimberley, TX
  • NPI 1215115167
  NPD (past)

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

{
    "created_epoch": "1251158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515542400000",
    "number": "1164655171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4303 VICTORY DR",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787047507",
            "telephone_number": "512-462-3627",
            "fax_number": "512-462-2898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4303 VICTORY DR",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787047507",
            "telephone_number": "512-462-3627",
            "fax_number": "512-462-2898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGENBROAD-ELANDER",
        "first_name": "SHAWN",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-25",
        "last_updated": "2018-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP118041",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "AP118041",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ageless Athlete PLLC
• Ageless Men's Health Holdings, Inc (Ageless Men's Health)
• Ageless Men's Health Holdings, Inc
• Ageless Men's Health PLLC
• Ageless Men's Health, PLLC
• Agi Counseling Services Inc
• Agile Psychiatry PLLC
• Agilitas USA Inc (Results Physiotherapy)
• Agilitas USA Inc. (Results Physiotherapy)
• Agilitas USA, Inc (Results Physiotherapy)

• Family Nurse Practitioner in Austin, TX
• Providers in Austin, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.