NPIMap

Organization Active NPI

Shannon Medical Center

Doing business as Shannon River Crest Hospital

  • Psychiatric Hospital Unit
  • San Angelo, TX
National Provider Identifier
1407681950
Registry record updated Sep 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
SHANNON MEDICAL CENTER
Doing business as
Shannon River Crest Hospital
Practice address
1636 Hunters Glen Rd
San Angelo, TX 76901-5008
Phone
(325) 949-5722
Fax
(325) 947-2054
NPI assigned
Sep 4, 2024
Last updated
Sep 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2024

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

Authorized official

Name
Joseph Wooldridge
Title
Cfo
Phone
(325) 657-5303

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X Primary

Addresses

Primary practice location

1636 Hunters Glen Rd
San Angelo, TX 76901-5008

Mailing address

PO Box 1879
San Angelo, TX 76902-1879
Phone (325) 747-8217

Other names 1

  • SHANNON RIVER CREST HOSPITAL Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241029002164 TX Part A Provider - Hospital 2860302767 Practice locations: San Angelo, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407681950. Details of each certification follow.

Hospital certification: CCN 45S571

Legal name
SHANNON MEDICAL CENTER
Doing business as
SHANNON RIVER CREST HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Aug 24, 1994 in TX
Enrollment address
1636 Hunters Glen Rd
San Angelo, TX 76901-5008
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Shannon Air Med 19 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
James a Boyd Individual Corporate DirectorBoard Member Oct 1, 2021
Leonard Mertz Individual Corporate DirectorBoard Member Jan 1, 1998
Amado M Castillo Individual Corporate DirectorBoard Member Oct 1, 2021
Oran Berry Individual Corporate DirectorBoard Member Jan 8, 2004
Shannon Health System Organization, San Angelo, TX Non-profit 5% Or Greater Direct Ownership Interest Apr 6, 1995 100%
Martha Visney Individual Corporate DirectorBoard Member Oct 1, 2021
Michael Weatherford Individual Corporate DirectorBoard Member Oct 1, 2016
Shannon West Texas Memorial Hospital Organization, San Angelo, TX Non-profit 5% Or Greater Indirect Ownership Interest Apr 6, 1995 100%
Michael Oliphant Individual Corporate DirectorBoard Member Aug 6, 2007
Ross a Harper Individual Corporate DirectorBoard Member Oct 1, 2022
Jeffrey G McCormick Individual Corporate DirectorBoard Member Oct 1, 2020
Kelly Plymell Individual Corporate OfficerCeo Jan 1, 2017
Corporate Director Jan 1, 2017
W-2 Managing EmployeeCeo Jan 1, 2017
Rudy Haddad Individual Corporate DirectorBoard Member Oct 1, 2025
Joseph Wooldridge Individual Corporate OfficerCfo May 16, 2019
W-2 Managing EmployeeCfo May 16, 2019
William C Griffis Individual Corporate DirectorBoard Member Oct 1, 2020
John Cecil Individual Corporate DirectorBoard Member Oct 1, 2007
Freddy L Moore Individual Corporate DirectorBoard Member Jun 1, 2020

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

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 Operational/Managerial Control Jan 1, 2010

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1725408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725408000000",
    "number": "1407681950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1879",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769021879",
            "telephone_number": "325-747-8217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1636 HUNTERS GLEN RD",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769015008",
            "telephone_number": "325-949-5722",
            "fax_number": "325-947-2054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANNON MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-04",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A",
        "authorized_official_last_name": "WOOLDRIDGE",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "325-657-5303"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHANNON RIVER CREST HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Angelo, TX

Sources for this page

Verify at the official NPI Registry.