Active NPI
Shane Alan Clark, MD
- Anesthesiology Physician
- Dallas, TX
National Provider Identifier
1265573067
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- M5105
- Practice address
- 6606 LBJ Fwy
Suite 200
Dallas, TX 75240-6533 - Phone
- (972) 715-5000
- Fax
- (972) 715-9976
- NPI assigned
- Feb 12, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | M5105 | TX | Primary |
Addresses
Primary practice location
6606 LBJ Fwy
Suite 200
Dallas, TX 75240-6533
Mailing address
PO Box 840853
Dallas, TX 75284-0853
Phone (972) 715-5000
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 186407609 | Medicaid | TX | |
| P01445776 | Other | TX | RAIRLAOD |
| 8EH505 | Other | TX | BCBS |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Anesthesiology
- Education
- University of Texas Medical School at San Antonio, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
10864 Texas Health TRL
Fort Worth, TX 76244-4897
Phone (817) 250-2150
Hospital & facility affiliations
- Texas Health Harris Methodist Hospital Alliance
- Texas Health Harris Methodist Hurst-Euless-Bedford
- Texas Health Arlington Memorial Hospital
- Texas Health Harris Methodist Hospital Southlake
Merit-based Incentive Payment System (MIPS)
- Final score
- 88.94 of 100
- Quality
- 91.31
- Improvement activities
- 40
- Cost
- 79.05
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| U S Anesthesia Partners of Texas, PA | Anesthesiology | Current | Accepting new patients |
| U. S. Anesthesia Partners of Texas, P.a., | Anesthesiology | Current | Accepting new patients |
| Bellville Medical Center | Past | Accepting new patients | |
| Bellville Hospital District | Past | Accepting new patients |
Locations
303 Sandy Corner Rd
El Campo, TX 77437
Phone (979) 543-6251
10864 Texas Health Trl
Fort Worth, TX 76244
Phone (682) 212-2000
1800 Park Place Ave
Ft Worth, TX 76110
Phone (682) 703-5600
7600 Beechnut St
Houston, TX 77074
Phone (713) 456-5000
100 Medical Dr
Lake Jackson, TX 77566
Phone (713) 496-7555
4401 Booth Calloway Rd
Richland Hls, TX 76180
Phone (817) 255-1000
9250 Pinecroft Dr
Shenandoah, TX 77380
Phone (281) 364-2300
Organizations & group practices 4
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.
-
- Anesthesiology Physician
- Houston, TX
- NPI 1548208564
-
- Interventional Pain Medicine Physician
- Addison, TX
- NPI 1053800391
Anesthesiology
-
- General Acute Care Hospital
- Bellville, TX
- NPI 1457358103
-
- General Acute Care Hospital
- Bellville, TX
- NPI 1477857332
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Southlake, TX
- NPI 1629064928
-
- General Acute Care Hospital
- Arlington, TX
- NPI 1174533343
-
- General Acute Care Hospital
- Fort Worth, TX
- NPI 1215296884
-
- General Acute Care Hospital
- Bedford, TX
- NPI 1104845015
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643587200000",
"number": "1265573067",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 840853",
"city": "DALLAS",
"state": "TX",
"postal_code": "752840853",
"telephone_number": "972-715-5000",
"fax_number": "972-715-9976"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6606 LBJ FWY",
"address_2": "SUITE 200",
"city": "DALLAS",
"state": "TX",
"postal_code": "752406533",
"telephone_number": "972-715-5000",
"fax_number": "972-715-9976"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "SHANE",
"middle_name": "ALAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-12",
"last_updated": "2022-01-31",
"certification_date": "2022-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "TX",
"license": "M5105",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "186407609",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAIRLAOD",
"identifier": "P01445776",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "8EH505",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2022; 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.