Shane M Tackitt, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

S5274 Issued in TX

Practice address

2700 E Broad St
Mansfield, TX 76063-5899

Phone

(682) 242-6470

Fax

(682) 622-2092

NPI assigned

Oct 12, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

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

Specialty

Internal Medicine

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lonestar Hospital Medicine Associates PAGroup PAC ID 6709049703, 126 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Methodist Mansfield Medical Center Hospital, Mansfield, TX, CCN 670023

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Lonestar Hospital Medicine Associates, PA

  • Hospitalist Physician
  • Mansfield, TX
  • NPI 1518237429

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Methodist Hospitals of Dallas

  • General Acute Care Hospital
  • Mansfield, TX
  • NPI 1689629941
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Methodist Hospitals of Dallas

  • General Acute Care Hospital
  • Mansfield, TX
  • NPI 1689629941
  Care Compare affiliation

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

{
    "created_epoch": "1444608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593561600000",
    "number": "1588035976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 E BROAD ST",
            "address_2": "DEPARTMENT INTERNAL MEDICINE",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760635899",
            "telephone_number": "682-242-6470",
            "fax_number": "682-622-2092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 E BROAD ST",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760635899",
            "telephone_number": "682-242-6470",
            "fax_number": "682-622-2092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACKITT",
        "first_name": "SHANE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-10-12",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "TX",
            "license": "S5274",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WA",
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": "BP10058725",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": "S5274",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "S5274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Magdalene Maria Szuszkiewicz-Garcia, MD
• T.O. Loving Care LLC
• Tan Ta
• Abel Nyakundi Tachiri
• Amy Christine Tackel, NP
• Jennifer Dawn Taggart, LPC
• James Anthony Tagle Jr., ACNP
• Allison Paige Talley, PT
• Tamara McJunkin, LPC, PLLC
• Desiree Tanner

• Internal Medicine Physician in Mansfield, TX
• Providers in Mansfield, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.