NPIMap

Individual provider Active NPI

Shannon Selbo, PA-C

  • Physician Assistant
  • Waco, TX
National Provider Identifier
1831478965
Registry record updated Oct 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA07219 Issued in TX
Practice address
7300 Bosque Blvd
Waco, TX 76710-4023
Phone
(254) 202-2600
Fax
(254) 202-2650
NPI assigned
Aug 7, 2011
Last updated
Oct 6, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA07219 TX Primary

Addresses

Primary practice location

7300 Bosque Blvd
Waco, TX 76710-4023

Mailing address

PO Box 848476
Dallas, TX 75284-8476
Phone (254) 202-4655

Other practice location 1

910 E Southlake Blvd
Southlake, TX 76092-6388
Phone (817) 421-5000

Other names 1

  • Shannon Skinner Former name

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
I20111011000720 TX Practitioner - Physician Assistant 0042482291 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

400 W LBJ Fwy
Suite 330
Irving, TX 75063-3717
Phone (972) 556-2885

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.09 of 100Reported as group
Quality
74.72
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PA07219TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Las Colinas Orthopedic Surgery & Sports Medicine P.a. CurrentSince Feb 21, 2015 Accepting new patients
Las Colinas Orthopedic Surgery and Sports Medicine P.a. CurrentSince Feb 21, 2015 Accepting new patients
Las Colinas Orthopedic Surgery and Sports Medicine P.a. Past Accepting new patients
Dallas County Hospital District Past Accepting new patients
Vickery Health Center Past Accepting new patients
Healthtexas Provider Network Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: shannon.selbo.1@15749.direct.athenahealth.com

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 1

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": "1312675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791244800000",
    "number": "1831478965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 848476",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752848476",
            "telephone_number": "254-202-4655",
            "fax_number": "254-202-4697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7300 BOSQUE BLVD",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767104023",
            "telephone_number": "254-202-2600",
            "fax_number": "254-202-2650"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "910 E Southlake Blvd",
            "address_purpose": "LOCATION",
            "city": "Southlake",
            "state": "TX",
            "postal_code": "760926388",
            "country_code": "US",
            "telephone_number": "817-421-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SELBO",
        "first_name": "SHANNON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-07",
        "last_updated": "2026-10-06",
        "certification_date": "2026-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA07219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "SKINNER",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Waco, TX

Sources for this page

Verify at the official NPI Registry.