Individual provider Active NPI

Kristin Ashley Debusk, FNP

  • Nurse Practitioner
  • San Angelo, TX
National Provider Identifier
1265082788
Registry record updated Sep 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP143054 Issued in TX
Practice address
102 N Magdalen St
San Angelo, TX 76903-5400
Phone
(325) 481-2025
Fax
(325) 481-2166
NPI assigned
Sep 17, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP143054 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) 658-1511

Other identifiers 1

IdentifierTypeStateIssuer
AP143054OtherTXLICENSE

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
I20191009003500 TX Practitioner - Nurse Practitioner 8325379076 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shannon ClinicGroup PAC ID 0840103727, 550 clinicians

Practice addresses (Care Compare)

102 N Magdalen
San Angelo, TX 76903
Phone (325) 747-1511

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
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP143054TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Shannon Clinic CurrentSince Sep 15, 2019 Accepting new patients
Shannon Clinic CurrentSince Sep 15, 2019 Accepting new patients

Locations

2104 N Bedell Ave
Ste A
Del Rio, TX 78840
Phone (830) 703-1604

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

102 N Magdalen St
San Angelo, TX 76903
Phone (325) 655-2200

Interoperability endpoints

  • Direct secure messaging: kdebusk31694@shannonhealth.direct-ci.com

Organizations & group practices 2

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

Hospital & facility affiliations 3

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": "1568678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568851200000",
    "number": "1265082788",
    "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": "325-658-1511",
            "fax_number": "325-481-2166"
        },
        {
            "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": "325-481-2025",
            "fax_number": "325-481-2166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEBUSK",
        "first_name": "KRISTIN",
        "middle_name": "ASHLEY",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-17",
        "last_updated": "2019-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP143054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "AP143054",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Angelo, TX

Sources for this page

Verify at the official NPI Registry.