Individual provider Active NPI

Shana Jordan, M.D.

  • Family Medicine Physician
  • Long Beach, CA
National Provider Identifier
1033140249
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A076315 Issued in CA
Practice address
1333 Chestnut Ave
Long Beach, CA 90813-2944
Phone
(562) 599-8601
Fax
(562) 218-0853
NPI assigned
Jul 5, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 A076315 CA Primary

Addresses

Primary practice location

1333 Chestnut Ave
Long Beach, CA 90813-2944

Mailing address

1000 W Carson St
N-25; #471
Torrance, CA 90502-2004
Phone (310) 222-3382

Other identifiers 1

IdentifierTypeStateIssuer
A076315OtherCALICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051212000792 CA Practitioner - Family Practice 6103847686 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Southern California Keck School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of Los AngelesGroup PAC ID 1850296534, 395 clinicians

Practice addresses (Care Compare)

1333 Chestnut Ave
Long Beach, CA 90813-2944
Phone (562) 753-2315

Hospital & facility affiliations

  • Lac/Harbor-UCLA Med Center Hospital, Torrance, CA, CCN 050376

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A076315CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of Los Angeles Current Accepting new patients
County of Los Angeles CurrentSince Oct 1, 2003 Accepting new patients
County of Los Angeles CurrentSince Oct 1, 2003 Accepting new patients

Locations

1000 S Fremont Ave
Unit 9
Alhambra, CA 91803

1333 Chestnut Ave
Long Beach, CA 90813
Phone (562) 599-8601

1000 W Carson St
#N25
Torrance, CA 90502

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1033140249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 W CARSON ST",
            "address_2": "N-25; #471",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905022004",
            "telephone_number": "310-222-3382",
            "fax_number": "310-222-2882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 CHESTNUT AVE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908132944",
            "telephone_number": "562-599-8601",
            "fax_number": "562-218-0853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "SHANA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A076315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "A076315",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.