Individual provider Active NPI

Tanya L Flynn, PA

  • Surgical Physician Assistant
  • San Angelo, TX
National Provider Identifier
1225380728
Registry record updated Nov 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA142012 Issued in TX
Practice address
102 N Magdalen St
San Angelo, TX 76903-5400
Phone
(325) 747-2344
Fax
(325) 747-2109
NPI assigned
Oct 8, 2012
Last updated
Nov 6, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA142012 TX Primary

Addresses

Primary practice location

102 N Magdalen St
San Angelo, TX 76903-5400

Mailing address

PO Box 22000
San Angelo, TX 76902-7200
Phone (325) 747-1511

Other identifiers 1

IdentifierTypeStateIssuer
1107819OtherTXNCCPA

Other names 1

  • Tanya L Favor Former name

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121220000137 TX Practitioner - Physician Assistant 4789836719 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shannon ClinicGroup PAC ID 0840103727, 550 clinicians

Practice addresses (Care Compare)

120 E Beauregard Ave
San Angelo, TX 76903-5919
Phone (325) 747-1511

120 E Harris Ave
San Angelo, TX 76903-5904
Phone (325) 747-6741

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.63 of 100Reported as group
Quality
78.21
Promoting interoperability
96
Improvement activities
40
Cost
67.22

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA142012TXMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Shannon Clinic CurrentSince Oct 22, 2012 Accepting new patients

Locations

102 N Magdalen St
San Angelo, TX 76903
Phone (325) 481-2025

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

215 E College Ave
San Angelo, TX 76903
Phone (915) 481-2294

Interoperability endpoints

  • Direct secure messaging: tfavor8477@shannonhealth.direct-ci.com

Organizations & group practices 1

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": "1349654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730851200000",
    "number": "1225380728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22000",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769027200",
            "telephone_number": "325-747-1511",
            "fax_number": "325-747-2165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 N MAGDALEN ST",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769035400",
            "telephone_number": "325-747-2344",
            "fax_number": "325-747-2109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLYNN",
        "first_name": "TANYA",
        "middle_name": "L",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-08",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "PA142012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA",
            "identifier": "1107819",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TANYA",
            "last_name": "FAVOR",
            "middle_name": "L",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in San Angelo, TX

Sources for this page

Verify at the official NPI Registry.