Ms Shannon Lesley Lange, CPNP-PC, CNS is a medicare enrolled "Nurse Practitioner - Pediatrics" physician in San Antonio, Texas. Her current practice location is
Brooke Army Medical Center, 3551 Roger Brooke Drive, San Antonio, Texas. You can reach out to her office (for appointments etc.) via phone at
(210) 916-3160.
Ms Shannon Lesley Lange is licensed to practice in Texas (license number 1013771) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1225513591.
Physician's Profile
| Full Name | Ms Shannon Lesley Lange |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Pediatrics |
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| Location | Brooke Army Medical Center, San Antonio, Texas |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1225513591
- Provider Enumeration Date: 10/02/2018
- Last Update Date: 08/04/2023
Medicare PECOS Information:
- PECOS PAC ID: 8628314580
- Enrollment ID: I20211018000935
Medical Identifiers
Medical identifiers for Ms Shannon Lesley Lange such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1225513591 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 208000000X | Pediatrics | NP95009977 (California) | Secondary |
| 363LP0200X | Nurse Practitioner - Pediatrics | 1013771 (Texas) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Ms Shannon Lesley Lange allows following entities to bill medicare on her behalf.
| Entity Name | Magella Medical Associates Billing Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1083631071
PECOS PAC ID: 8729970215
Enrollment ID: O20041115001144 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ms Shannon Lesley Lange is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Ms Shannon Lesley Lange, CPNP-PC, CNS
19th Medical Group 1090 Arnold Drive,
Little Rock Afb, AR 72099-4933
Ph: (501) 987-7446 | Ms Shannon Lesley Lange, CPNP-PC, CNS
Brooke Army Medical Center, 3551 Roger Brooke Drive,
San Antonio, TX 78234-4504
Ph: (210) 916-3160 |
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