Individual provider Active NPI

Toby Redden, CNP

  • Nurse Practitioner
  • San Angelo, TX
National Provider Identifier
1780091652
Registry record updated May 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP129004 Issued in TX
Practice address
1901 Johnson Ave
San Angelo, TX 76904-5048
Phone
(325) 942-2171
Fax
(325) 942-2133
NPI assigned
Jul 12, 2014
Last updated
May 16, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP129004 TX Primary

Addresses

Primary practice location

1901 Johnson Ave
San Angelo, TX 76904-5048

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
8163NTOtherTXBCBS

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151015001045 TX Practitioner - Nurse Practitioner 0143542027 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
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

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
Certified Nurse Practitioner, Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Regional Employee Assistance Program Inc Nurse Practitioner CurrentSince Sep 15, 2015 Accepting new patients
Regional Employee Assistance Program Inc Nurse Practitioner CurrentSince Sep 15, 2015 Accepting new patients
Regional Employee Assistance Program Inc Current Accepting new patients
Shannon Clinic CurrentSince Jan 1, 2016 Accepting new patients
Shannon Clinic CurrentSince Jan 1, 2016 Accepting new patients
Regional Employee Assistance Program Inc Past Accepting new patients

Locations

2804 Lake Rd
Ste 5
Huntsville, TX 77340
Phone (979) 696-2422

115 W 1st St
San Angelo, TX 76903
Phone (325) 481-2662

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

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

3535 Knickerbocker Rd
San Angelo, TX 76904
Phone (915) 947-6495

4235 Southwest Blvd
San Angelo, TX 76904
Phone (325) 658-9151

Organizations & group practices 6

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 2

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": "1405123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463356800000",
    "number": "1780091652",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 JOHNSON AVE",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769045048",
            "telephone_number": "325-942-2171",
            "fax_number": "325-942-2133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDDEN",
        "first_name": "TOBY",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-12",
        "last_updated": "2016-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP129004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8163NT",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Angelo, TX

Sources for this page

Verify at the official NPI Registry.