NPIMap

Individual provider Active NPI

Charles Shannon Childers, D.O.

  • Family Medicine Physician
  • De Leon, TX
National Provider Identifier
1235119629
Registry record updated May 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
H7961 Issued in TX
Practice address
1100 W Reynosa Ave
De Leon, TX 76444-1630
Phone
(254) 893-5895
Fax
(888) 895-1214
NPI assigned
Jan 20, 2006
Last updated
May 2, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X H7961 TX Primary

Addresses

Primary practice location

1100 W Reynosa Ave
De Leon, TX 76444-1630

Mailing address

PO Box 30
De Leon, TX 76444-0482
Phone (254) 893-5895

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110720000807 TX Practitioner - Family Practice 6901074830 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Texas HSC, College of Osteopathic Med, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1100 W Reynosa Ave
De Leon, TX 76444-1630
Phone (254) 893-5895

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Cross Timbers Health Clinics, Inc. Current Accepting new patients
Cross Timbers Health Clinics, Inc CurrentSince Dec 1, 2020 Accepting new patients
Cross Timbers Health Clinics, Inc CurrentSince Dec 1, 2020 Accepting new patients

Locations

1100 W Reynosa Ave
De Leon, TX 76444
Phone (254) 893-5895

135 River North Blvd
Stephenville, TX 76401
Phone (254) 965-2810

Interoperability endpoints

  • Direct secure messaging: charles.childers@ahctx.eclinicaldirectplus.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/CEAGCD
  • FHIR API: https://fhir4.healow.com/fhir/r4/CEAGCD/Endpoint/CEAGCD

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Frontier HospiceCleveland, TN, CCN 447552 Home health agency Contracted Managing Employee
W-2 Managing Employee		 Dec 3, 2025
Dec 3, 2025
Frontier HospiceBenbrook, TX, CCN 741720 Hospice Contracted Managing Employee
W-2 Managing Employee		 Dec 3, 2025
Dec 3, 2025
AccelhealthDe Leon, TX, CCN 451850 Federally qualified health center W-2 Managing Employee Nov 1, 2021
AccelhealthStephenville, TX, CCN 671963 Federally qualified health center W-2 Managing Employee Dec 1, 2020
AccelhealthBrownwood, TX, CCN 671979 Federally qualified health center W-2 Managing Employee Dec 1, 2020

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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 4

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": "1137715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682985600000",
    "number": "1235119629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30",
            "city": "DE LEON",
            "state": "TX",
            "postal_code": "764440482",
            "telephone_number": "254-893-5895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 W REYNOSA AVE",
            "city": "DE LEON",
            "state": "TX",
            "postal_code": "764441630",
            "telephone_number": "254-893-5895",
            "fax_number": "888-895-1214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHILDERS",
        "first_name": "CHARLES",
        "middle_name": "SHANNON",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-20",
        "last_updated": "2023-05-02",
        "certification_date": "2023-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "H7961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in De Leon, TX

Sources for this page

Verify at the official NPI Registry.