NPIMap

Organization Active NPI

South Bay Cardiovascular Medical Group, Inc

  • Specialist
  • San Jose, CA
National Provider Identifier
1003148073
Registry record updated Aug 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A50310 Issued in CA
Legal business name
SOUTH BAY CARDIOVASCULAR MEDICAL GROUP, INC
Practice address
105 N Bascom Ave
Suite 204
San Jose, CA 95128-1811
Phone
(408) 918-0400
Fax
(408) 286-2922
NPI assigned
Feb 2, 2010
Last updated
Aug 30, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2017

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

Authorized official

Name
Mohammad Shenasa, M.D.NPI 1578621074
Title
Owner
Phone
(408) 918-0400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X A50310 CA Primary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X

Addresses

Primary practice location

105 N Bascom Ave
Suite 204
San Jose, CA 95128-1811

Mailing address

105 N Bascom Ave
Suite 204
San Jose, CA 95128-1811
Phone (408) 918-0400

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1265068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1504051200000",
    "number": "1003148073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 N BASCOM AVE",
            "address_2": "SUITE 204",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951281811",
            "telephone_number": "408-918-0400",
            "fax_number": "408-286-2922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 N BASCOM AVE",
            "address_2": "SUITE 204",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951281811",
            "telephone_number": "408-918-0400",
            "fax_number": "408-286-2922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BAY CARDIOVASCULAR MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-02",
        "last_updated": "2017-08-30",
        "status": "A",
        "authorized_official_last_name": "SHENASA",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "408-918-0400",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A50310",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.