Individual provider Active NPI

Shane Alan Hervey, MD

  • Family Medicine Physician
  • Santa Monica, CA
National Provider Identifier
1043899784
Registry record updated Aug 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A191828 Issued in CA
Practice address
1225 15TH St Ste 2100
Santa Monica, CA 90404-1101
Phone
(310) 319-1234
NPI assigned
Apr 7, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2025

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 A191828 CA Primary

Addresses

Primary practice location

1225 15TH St Ste 2100
Santa Monica, CA 90404-1101

Mailing address

5767 W Century Blvd Ste 400
Los Angeles, CA 90045-5631

Other practice location 1

1001 Potrero Ave Bldg 80-83
San Francisco, CA 94110-3518
Phone (628) 206-5252

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
I20250616002756 CA Practitioner - Family PracticePractitioner - Sports Medicine 9638562770 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
Oregon Health Sciences University School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Regents of the University of CaliforniaGroup PAC ID 2062312291, 71 clinicians

Practice addresses (Care Compare)

100 Medical Plaza
Suite 170
Los Angeles, CA 90095-0001
Phone (310) 319-1234

1250 16TH St
Santa Monica, CA 90404-1249

403 W Adams Blvd
Los Angeles, CA 90007-2664
Phone (213) 742-1162

Hospital & facility affiliations

  • Ronald Reagan UCLA Medical Center Hospital, Los Angeles, CA, CCN 050262
  • Santa Monica - UCLA Med Ctr & Orthopaedic Hospital Hospital, Santa Monica, CA, CCN 050112

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A191828CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California CurrentSince Aug 1, 2025 Accepting new patients
Regents of the University of California CurrentSince Aug 1, 2025 Accepting new patients
UCLA Medical Group Family Medicine Past Accepting new patients

Locations

100 UCLA Medical Plz
Ste 170
Los Angeles, CA 90024
Phone (858) 534-3880

File 54206
Los Angeles, CA 90074

5767 W Century Blvd
Ste 400
Los Angeles, CA 90045
Phone (310) 301-5200

1111 W Inyokern Rd
Ste B
Ridgecrest, CA 93555
Phone (760) 301-6945

1250 16th St
Santa Monica, CA 90404
Phone (310) 301-8695

1225 15th St
Ste 2100
Santa Monica, CA 90404
Phone (424) 259-6560

1131 Wilshire Blvd
Ste 100
Santa Monica, CA 90401
Phone (310) 458-2381

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 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": "1617753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754006400000",
    "number": "1043899784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 15TH ST STE 2100",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904041101",
            "telephone_number": "310-319-1234"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1001 Potrero Ave Bldg 80-83",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941103518",
            "country_code": "US",
            "telephone_number": "628-206-5252",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HERVEY",
        "first_name": "SHANE",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-07",
        "last_updated": "2025-08-01",
        "certification_date": "2025-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A191828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

Verify at the official NPI Registry.