Individual provider Active NPI

Charles Justin Garrett, M.D.

  • Anesthesiology Physician
  • San Angelo, TX
National Provider Identifier
1518143841
Registry record updated Dec 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
P2647 Issued in TX
Practice address
3501 Knickerbocker Rd
San Angelo, TX 76904-7610
Phone
(325) 949-9555
NPI assigned
Jan 16, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 5, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 002065 GA
Anesthesiology Physician 207L00000X 200201249 NC
Anesthesiology Physician 207L00000X P2647 TX Primary

Addresses

Primary practice location

3501 Knickerbocker Rd
San Angelo, TX 76904-7610

Mailing address

3605 Executive Dr
San Angelo, TX 76904-6884
Phone (325) 949-9555

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
I20120525000101 TX Practitioner - Anesthesiology 4587715420 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Tennessee, HSC, College of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shannon ClinicGroup PAC ID 0840103727, 550 clinicians

Practice addresses (Care Compare)

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

120 E Harris Ave
San Angelo, TX 76903-5904
Phone (325) 747-6741

3605 Executive Dr
San Angelo, TX 76904-6884
Phone (325) 747-1511

Hospital & facility affiliations

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

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
002065GAMDAnesthesiology Physician
200201249NCMDAnesthesiology Physician
P2647TXMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Shannon Clinic Anesthesiology CurrentSince Mar 1, 2021 Accepting new patients

Locations

3501 Knickerbocker Rd
San Angelo, TX 76904
Phone (325) 947-6361

3555 Knickerbocker Rd
San Angelo, TX 76904
Phone (325) 224-5411

3605 Executive Dr
San Angelo, TX 76904
Phone (325) 949-9555

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

Organizations & group practices 1

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 1

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": "1200441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543968000000",
    "number": "1518143841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3605 EXECUTIVE DR",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769046884",
            "telephone_number": "325-949-9555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3501 KNICKERBOCKER RD",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769047610",
            "telephone_number": "325-949-9555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARRETT",
        "first_name": "CHARLES",
        "middle_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-01-16",
        "last_updated": "2018-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "GA",
            "license": "002065",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NC",
            "license": "200201249",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TX",
            "license": "P2647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Angelo, TX

Sources for this page

Verify at the official NPI Registry.