NPIMap

Individual provider Active NPI

Viki A. Forlano, MD

  • Family Medicine Physician
  • San Angelo, TX
National Provider Identifier
1376547216
Registry record updated Sep 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
H6647 Issued in TX
Practice address
4235 Sunset Dr
San Angelo, TX 76904-5653
Phone
(325) 481-2197
Fax
(325) 659-0180
NPI assigned
Jun 9, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2015

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 H6647 TX Primary

Addresses

Primary practice location

4235 Sunset Dr
San Angelo, TX 76904-5653

Mailing address

PO Box 22000
San Angelo, TX 76902-7200
Phone (325) 481-2197

Other identifiers 1

IdentifierTypeStateIssuer
133474005MedicaidTX

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
I20070607000248 TX Practitioner - General Practice 3971601402 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Texas Tech University Health Science Center School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Shannon ClinicGroup PAC ID 0840103727, 550 clinicians
The West Texas Rehabilitation CenterGroup PAC ID 2860301215, shared by 5 NPIs, 444 clinicians

Practice addresses (Care Compare)

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

4601 Hartford St
Abilene, TX 79605-4603
Phone (325) 793-3411

Hospital & facility affiliations

  • Paradigm Homecare Home health agency, San Angelo, TX, CCN 747233
  • Enhabit Home Health Home health agency, Abilene, TX, CCN 679184
  • Centerwell Home Health Home health agency, Eastland, TX, CCN 457128
  • Country Home Health Home health agency, San Angelo, TX, CCN 679469
  • Shannon Home Health Services Home health agency, San Angelo, TX, CCN 457646
  • Gentiva Hospice, San Angelo, TX, CCN 451697
  • Shannon Medical Center Hospital, San Angelo, TX, CCN 450571
  • Ballinger Memorial Hospital Hospital, Ballinger, TX, CCN 451310
  • Park Plaza Nursing and Rehabilitation Center Nursing home, San Angelo, TX, CCN 675982
  • Regency House Nursing home, San Angelo, TX, CCN 675767

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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
J6647TXMDPulmonary Disease Physician
H6647TXMDPublic Health & General Preventive Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Shannon Clinic Family Medicine CurrentSince Oct 25, 2009 Accepting new patients
Shannon Clinic Family Medicine Past Accepting new patients

Locations

4235 Sunset Dr
San Angelo, TX 76904
Phone (325) 481-2197

120 E Harris Ave
San Angelo, TX 76903
Phone (325) 653-6741

4235 Southwest Blvd
San Angelo, TX 76904
Phone (325) 658-9151

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

Interoperability endpoints

  • Direct secure messaging: vforlano6631@shannonhealth.direct-ci.com

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Family Health Center of OzonaOzona, TX, CCN 673841 Rural health clinic Corporate Director Oct 1, 2007

Owned or controlled facilities with NPI records 1

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

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 11

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": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443484800000",
    "number": "1376547216",
    "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": "325-481-2197",
            "fax_number": "325-659-0180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4235 SUNSET DR",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769045653",
            "telephone_number": "325-481-2197",
            "fax_number": "325-659-0180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORLANO",
        "first_name": "VIKI",
        "middle_name": "A.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-09",
        "last_updated": "2015-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "H6647",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "133474005",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Angelo, TX

Sources for this page

Verify at the official NPI Registry.