NPIMap

Individual provider Active NPI

Shawn A Stussy, MD

  • Family Medicine Physician
  • Wake Village, TX
National Provider Identifier
1821082835
Registry record updated Jun 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
K1938 Issued in TX
Practice address
5212 W 7TH St
Wake Village, TX 75501-5930
Phone
(903) 831-6848
Fax
(903) 223-7089
NPI assigned
Sep 6, 2005
Last updated
Jun 13, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X K1938 TX Primary

Addresses

Primary practice location

5212 W 7TH St
Wake Village, TX 75501-5930

Mailing address

2101 Galleria Oaks Dr
Texarkana, TX 75503-4625
Phone (903) 791-9120

Other identifiers 2

IdentifierTypeStateIssuer
5011750001OtherTXCIGNA GOVERNMENT SERVICES
040099604MedicaidTX

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
I20040326000497 TX Practitioner - Family Practice 9830081686 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Arkansas College of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Family Medical Group of TexarkanaGroup PAC ID 3870485626, 12 clinicians

Practice addresses (Care Compare)

5212 W 7TH St
Wake Village, TX 75501-5930
Phone (903) 831-6848

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions28
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
K1938TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Medical Group of Texarkana Family Medicine CurrentSince Feb 1, 2004 Accepting new patients

Locations

2101 Galleria Oaks Dr
Texarkana, TX 75503
Phone (903) 791-9120

5212 W 7th St
Wake Village, TX 75501
Phone (903) 791-9120

Interoperability endpoints

  • Direct secure messaging: shawnstussy@fmgt.allscriptsdirect.net

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Enhabit HospiceTexarkana, TX, CCN 451785 Hospice Contracted Managing Employee Sep 1, 2016

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 1

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 10

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": "1125964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402617600000",
    "number": "1821082835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 GALLERIA OAKS DR",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755034625",
            "telephone_number": "903-791-9120",
            "fax_number": "903-791-9132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5212 W 7TH ST",
            "city": "WAKE VILLAGE",
            "state": "TX",
            "postal_code": "755015930",
            "telephone_number": "903-831-6848",
            "fax_number": "903-223-7089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUSSY",
        "first_name": "SHAWN",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-06",
        "last_updated": "2014-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K1938",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA GOVERNMENT SERVICES",
            "identifier": "5011750001",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "040099604",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wake Village, TX

Sources for this page

Verify at the official NPI Registry.