Teagan Nichole Charles, MPAS, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA11878 Issued in TX

Practice address

25723 Old Fredericksburg Rd
Boerne, TX 78015

Phone

(210) 450-6800

Fax

(210) 450-6801

NPI assigned

May 11, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Westover Hills DermatologyGroup PAC ID 4789968835, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: teagan@sonterraderm.emadirect.md

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.

• Westover Hills Dermatology

  • Specialist
  • San Antonio, TX
  • NPI 1366980047
  Medicare reassignment Care Compare group
• University of Texas Health Science Center at San Antonio

  • Internal Medicine Physician
  • San Antonio, TX
  • NPI 1720051717
  Medicare reassignment NPD
• The University of Texas Health Science Center at San Antonio

  • General Acute Care Hospital
  • San Antonio, TX
  • NPI 1326829904
  NPD

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

{
    "created_epoch": "1525996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639094400000",
    "number": "1609366921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25723 OLD FREDERICKSBURG RD",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "780156605",
            "telephone_number": "210-450-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25723 OLD FREDERICKSBURG RD",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "78015",
            "telephone_number": "210-450-6800",
            "fax_number": "210-450-6801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHARLES",
        "first_name": "TEAGAN",
        "middle_name": "NICHOLE",
        "credential": "MPAS, PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-11",
        "last_updated": "2021-12-10",
        "certification_date": "2021-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA11878",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CSHCN",
            "identifier": "385151102",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "385151101",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ana Rusu Cerean, FNP
• Jacqlyn Cervantes
• Laura Cervantes, LVN
• Alexandra Chaheine, PA-C
• Don Chamberlain, AU.D.
• Charleston Boerne Operations, LLC
• Crystal Haydee Chavez, M.D.
• Lauren Alexandria Chavez
• Richard L Childers, DPM
• Cibolo Counseling and Life Coaching

• Physician Assistant in Boerne, TX
• Providers in Boerne, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2021; 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.