Individual provider Active NPI

Shannon Gettel Ferguson, PA

  • Physician Assistant
  • Fort Worth, TX
National Provider Identifier
1407294259
Registry record updated Jan 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA08483 Issued in TX
Practice address
5750 W Vickery Blvd Ste 104
Fort Worth, TX 76107-7448
Phone
(817) 732-2878
Fax
(817) 732-9315
NPI assigned
Jun 13, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA08483 TX Primary

Addresses

Primary practice location

5750 W Vickery Blvd Ste 104
Fort Worth, TX 76107-7448

Mailing address

5750 W Vickery Blvd Ste 104
Fort Worth, TX 76107-7448
Phone (817) 732-2878

Other names 1

  • Shannon Leigh Gettel Former name

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
I20130927000254 TX Practitioner - Physician Assistant 4981838281 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Texas Health Physicians GroupGroup PAC ID 4385535954, 1,364 clinicians

Practice addresses (Care Compare)

1600 Hospital Pkwy
Bedford, TX 76022-6913
Phone (817) 684-2708

5750 W Vickery Blvd
Suite 104
Fort Worth, TX 76107-7448
Phone (817) 732-2878

8440 Walnut Hill LN
Suite 800
Dallas, TX 75231-3825
Phone (214) 345-5999

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Health Physicians Group CurrentSince Jul 15, 2013 Accepting new patients

Locations

1600 Hospital Pkwy
Bedford, TX 76022
Phone (817) 355-7803

5750 W Vickery Blvd
Ste 104
Fort Worth, TX 76107
Phone (817) 732-2878

Interoperability endpoints

  • Direct secure messaging: sferguson196520@direct.texashealth.org

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": "1371081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1514851200000",
    "number": "1407294259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5750 W VICKERY BLVD STE 104",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761077448",
            "telephone_number": "817-732-2878",
            "fax_number": "817-732-9315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5750 W VICKERY BLVD STE 104",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761077448",
            "telephone_number": "817-732-2878",
            "fax_number": "817-732-9315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERGUSON",
        "first_name": "SHANNON",
        "middle_name": "GETTEL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-13",
        "last_updated": "2018-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA08483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "GETTEL",
            "middle_name": "LEIGH",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.