Individual provider Active NPI

Nancy Shan, M.D.

  • Pediatrics Physician
  • Houston, TX
National Provider Identifier
1316367154
Registry record updated Mar 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
R9431 Issued in TX
Practice address
1102 Bates Ave # Fc1860
Houston, TX 77030-2617
Phone
(832) 824-5447
Fax
(832) 824-0341
NPI assigned
Apr 20, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X R9431 TX Primary

Addresses

Primary practice location

1102 Bates Ave # Fc1860
Houston, TX 77030-2617

Mailing address

505 S Main St
Suite 525
Orange, CA 92868-4509
Phone (714) 456-5631

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200721003978 TX Practitioner - Pediatric Medicine 4981902038 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
140433CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Children'S Physician Group Pediatrics CurrentSince Jun 19, 2020 Accepting new patients
University of California Irvine Past Accepting new patients

Locations

8611 N Mopac Expy
Austin, TX 78759
Phone (713) 816-1250

1102 Bates Ave
Ste 1860
Houston, TX 77030
Phone (832) 824-5447

6701 Fannin St
Houston, TX 77030
Phone (832) 822-1764

6651 Main St
Va Hospital, TX 77030
Phone (832) 826-3000

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.

NPI Registry JSON

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

{
    "created_epoch": "1397952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710547200000",
    "number": "1316367154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 S MAIN ST",
            "address_2": "SUITE 525",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928684509",
            "telephone_number": "714-456-5631",
            "fax_number": "714-285-0389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 BATES AVE # FC1860",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770302617",
            "telephone_number": "832-824-5447",
            "fax_number": "832-824-0341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAN",
        "first_name": "NANCY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-20",
        "last_updated": "2024-03-16",
        "certification_date": "2024-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "R9431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.