Active NPI
Shellie Alesha Reagan, DDS
- Dentist
- Spring, TX
National Provider Identifier
1902910540
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 15755
- Practice address
- 8419 Louetta Rd
Suite a
Spring, TX 77379-6737 - Phone
- (281) 401-8200
- Fax
- (281) 401-8201
- NPI assigned
- Aug 19, 2006
- Last updated
- Aug 27, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 15755 | TX | Primary |
Addresses
Primary practice location
8419 Louetta Rd
Suite a
Spring, TX 77379-6737
Mailing address
8419 Louetta Road
Suite a
Spring, TX 77375
Phone (281) 401-8200
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 681227 | Other | TX | UNITED CONCORDIA |
| 15755 | Other | TX | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Dec 15, 2015 through Dec 15, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15755 | TX | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Champions Dentistry PLLC | Past | Accepting new patients |
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.
-
- General Practice Dentistry
- Spring, TX
- NPI 1043842156
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346025600000",
"number": "1902910540",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8419 LOUETTA ROAD",
"address_2": "SUITE A",
"city": "SPRING",
"state": "TX",
"postal_code": "77375",
"telephone_number": "281-401-8200",
"fax_number": "281-401-8201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8419 LOUETTA RD",
"address_2": "SUITE A",
"city": "SPRING",
"state": "TX",
"postal_code": "773796737",
"telephone_number": "281-401-8200",
"fax_number": "281-401-8201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REAGAN",
"first_name": "SHELLIE",
"middle_name": "ALESHA",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-19",
"last_updated": "2012-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "15755",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "681227",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "15755",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Spring, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2012; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.