NPIMap

Individual provider Active NPI

Aleksandra Vidacic, MD

  • Internal Medicine Physician
  • San Angelo, TX
National Provider Identifier
1629272224
Registry record updated Dec 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
N4181 Issued in TX
Practice address
120 E Harris Ave
San Angelo, TX 76903-5904
Phone
(325) 653-6741
Fax
(325) 481-2166
NPI assigned
Jun 14, 2007
Last updated
Dec 2, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X BP10026411 TX
Internal Medicine Physician 207R00000X N4181 TX Primary

Addresses

Primary practice location

120 E Harris Ave
San Angelo, TX 76903-5904

Mailing address

PO Box 22000
San Angelo, TX 76902-7200
Phone (325) 658-1511

Other identifiers 5

IdentifierTypeStateIssuer
206611003MedicaidTX
206611007MedicaidTX
3864783243OtherMYUTMB 3864783243-COMMERCIAL NUMBER
206611006MedicaidTX
206611002MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090904000303 TX Practitioner - Internal Medicine 6901951474 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shannon ClinicGroup PAC ID 0840103727, 550 clinicians
Dr.Av, PLLCGroup PAC ID 4981837879, 2 clinicians
Citizens Medical Center County of VictoriaGroup PAC ID 3577785096, 102 clinicians

Practice addresses (Care Compare)

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

210 Lee Barton Dr
Suite 206
Austin, TX 78704-1044
Phone (832) 962-8656

2701 Hospital Dr
Victoria, TX 77901-5748

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
BP10026411TXMDInternal Medicine Physician
N4181TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Citizen's Medical Center County of Victoria Internal Medicine CurrentSince Jul 1, 2016 Accepting new patients
Hospitalist Medicine Physicians of Texas, PLLC Internal Medicine CurrentSince Aug 17, 2017 Accepting new patients
Shannon Clinic Internal Medicine CurrentSince Dec 9, 2014 Accepting new patients
Dr. Av, PLLC Internal Medicine CurrentSince Dec 28, 2013 Accepting new patients
Cogent Healthcare of Texas, PA Internal Medicine CurrentSince Feb 1, 2019 Accepting new patients
Post Acute Medical at Luling LLC Past Accepting new patients
Hospitalists of South Texas, PA Past Accepting new patients

Locations

11113 Research Blvd
Austin, TX 78759
Phone (512) 324-1125

12221 N Mopac Expy
Austin, TX 78758
Phone (512) 901-2530

601 E 15th St
Austin, TX 78701
Phone (512) 324-7868

3201 W State Highway 22
Corsicana, TX 75110
Phone (903) 654-6800

18951 N Memorial Dr
Humble, TX 77338
Phone (281) 319-8409

6001 Kyle Pkwy
Kyle, TX 78640
Phone (512) 504-5000

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

120 E Harris Ave
San Angelo, TX 76903
Phone (325) 653-6741

2600 Saint Michael Dr
Texarkana, TX 75503
Phone (903) 614-1000

2701 Hospital Dr
Victoria, TX 77901
Phone (361) 573-9180

2701 Hospital Dr
Fl 6
Victoria, TX 77901
Phone (361) 572-5113

Interoperability endpoints

  • Direct secure messaging: avidacic8604@shannonhealth.direct-ci.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1181779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417478400000",
    "number": "1629272224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22000",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769027200",
            "telephone_number": "325-658-1511",
            "fax_number": "325-481-2166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 E HARRIS AVE",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769035904",
            "telephone_number": "325-653-6741",
            "fax_number": "325-481-2166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIDACIC",
        "first_name": "ALEKSANDRA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-14",
        "last_updated": "2014-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "BP10026411",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "N4181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206611003",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206611007",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MYUTMB 3864783243-COMMERCIAL NUMBER",
            "identifier": "3864783243",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206611006",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206611002",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Angelo, TX

Sources for this page

Verify at the official NPI Registry.