Individual provider Active NPI

Shamail S. Tariq, MD

  • Interventional Cardiology Physician
  • Fullerton, CA
National Provider Identifier
1033370358
Registry record updated Jan 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
A116248 Issued in CA
Practice address
100 E Valencia Mesa Dr Ste 206
Fullerton, CA 92835-3817
Phone
(714) 446-5050
NPI assigned
Jun 19, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Cardiology Physician 207RI0011X 2016007040 MO
Interventional Cardiology Physician 207RI0011X A116248 CA Primary

Addresses

Primary practice location

100 E Valencia Mesa Dr Ste 206
Fullerton, CA 92835-3817

Mailing address

100 E Valencia Mesa Dr Ste 206
Fullerton, CA 92835-3817
Phone (714) 446-5050

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, CA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160321001944 MO Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 3375840218 Reassigns benefits to 1 organization
I20230119001508 CA Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology) 3375840218 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Cardiovascular Disease (Cardiology)
Education
University of Missouri, Kansas City, School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians
Manzoor Tariq, Inc.Group PAC ID 1052471166, 2 clinicians

Practice addresses (Care Compare)

100 E Valencia Mesa Dr
Suite 105
Fullerton, CA 92835-3816
Phone (714) 871-3006

1071 Airport Rd
Festus, MO 63028-4103
Phone (636) 937-7485

1140 W la Veta Ave
Suite 430
Orange, CA 92868-4226
Phone (714) 543-5555

1950 Sunny Crest Dr
Suite 2900
Fullerton, CA 92835-3641
Phone (714) 992-5350

200 W Ctr St Promenade
Anaheim, CA 92805-3960

253 S Diamond Bar Blvd
Diamond Bar, CA 91765-1606
Phone (909) 860-1144

8078 E Santa Ana Canyon Rd
Anaheim, CA 92808-1108
Phone (714) 974-2900

Hospital & facility affiliations

  • Providence St. Jude Medical Center Hospital, Fullerton, CA, CCN 050168

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting12
Pacemaker insertion or repair1-10
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A116248CAMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation CurrentSince Dec 10, 2022 Accepting new patients
Providence Medical Foundation Past Accepting new patients
St Jude Hospital Inc Past Accepting new patients

Locations

200 W Ctr St Promenade
Ste 300
Anaheim, CA 92805
Phone (714) 449-4841

100 E Valencia Mesa Dr
Ste 206
Fullerton, CA 92835
Phone (714) 446-5050

100 E Valencia Mesa Dr
Ste 105
Fullerton, CA 92835
Phone (714) 446-5200

1950 Sunny Crest Dr
Ste 2900
Fullerton, CA 92835

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: stariq2507211@oc.providencedirect.org

Organizations & group practices 5

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 2

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": "1213833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673308800000",
    "number": "1033370358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E VALENCIA MESA DR STE 206",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353817",
            "telephone_number": "714-446-5050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E VALENCIA MESA DR STE 206",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353817",
            "telephone_number": "714-446-5050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TARIQ",
        "first_name": "SHAMAIL",
        "middle_name": "S.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-19",
        "last_updated": "2023-01-10",
        "certification_date": "2023-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "MO",
            "license": "2016007040",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "CA",
            "license": "A116248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fullerton, CA

Sources for this page

Verify at the official NPI Registry.