Shaylon Dwayne Rettig, M.D.

Primary specialty

Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X

License

L9869 Issued in TX

Practice address

333 N Santa Rosa St
San Antonio, TX 78207-3108

Phone

(210) 704-4708

NPI assigned

Jul 24, 2006

Last updated

Jun 17, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Baylor College of Medicine

  dba BCM Physicians of San Antonio

  • Pediatrics Physician
  • San Antonio, TX
  • NPI 1285079764
  Medicare reassignment NPD
• Greater San Antonio Emergency Physicians, PA

  • Emergency Medicine Physician
  • San Antonio, TX
  • NPI 1134184831
  NPD (past)
• River City Pediatric Emergency Physicians, PLLC

  • Pediatric Emergency Medicine (Emergency Medicine) Physician
  • San Antonio, TX
  • NPI 1972816692
  NPD (past)

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623888000000",
    "number": "1679595045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 N SAN SABA",
            "address_2": "SUITE 1135",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782073154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 N SANTA ROSA ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782073108",
            "telephone_number": "210-704-4708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RETTIG",
        "first_name": "SHAYLON",
        "middle_name": "DWAYNE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2021-06-17",
        "certification_date": "2021-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TX",
            "license": "L9869",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "TX",
            "license": "L9869",
            "primary": true
        },
        {
            "code": "2080S0010X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Sports Medicine",
            "state": "TX",
            "license": "L9869",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP",
            "identifier": "184276701",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "174284303",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PO#174284301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Retina and Vitreous of San Antonio
• Retina Associates of South Texas, P.a.
• Retina Specialists of San Antonio, PLLC
• Retinal Consultants of San Antonio
• Jesse J. Rettele, L/CPO
• Veronica Rettig, MSNA
• Jennifer Suzanne Retzloff, M.D.
• Matthew Gerard Retzloff, M.D.
• Aliese Marie Reus, PHARMD
• Madison Grace Reuther, COTA

• Pediatric Emergency Medicine (Pediatrics) Physician in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Pediatric Emergency Medicine (Pediatrics) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.