Individual provider Active NPI

Shahida Parveen, M.D

  • Psychiatric Hospital
  • San Diego, CA
National Provider Identifier
1053549998
Registry record updated Oct 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
A106558 Issued in CA
Practice address
3420 Kenyon St
San Diego, CA 92110-5001
Phone
(877) 496-0450
NPI assigned
Jun 30, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X A106558 CA Primary

Addresses

Primary practice location

3420 Kenyon St
San Diego, CA 92110-5001

Mailing address

3420 Kenyon St
San Diego, CA 92110-5001
Phone (877) 496-0450

Other names 1

  • Dr. Shahida Khan Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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
I20100729000468 CA Practitioner - Psychiatry 9335272269 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

17140 Bernardo Ctr Dr
San Diego, CA 92128-2093
Phone (800) 290-5000

4647 Zion Ave
San Diego, CA 92120-2507
Phone (619) 528-5000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
106558CAMDMarriage & Family Therapist
A106558CAMDPsychiatric Hospital

Practice roles

OrganizationSpecialtyStatusNew patients
County of San Diego Psychiatric Hospital Current Accepting new patients
County of San Diego CurrentSince Apr 26, 2010 Accepting new patients
Southern California Permanente Medical Group CurrentSince Aug 13, 2011 Accepting new patients
County of San Diego CurrentSince Apr 26, 2010 Accepting new patients
Southern California Permanente Medical Group CurrentSince Aug 13, 2011 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients

Locations

393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914

3420 Kenyon St
San Diego, CA 92110
Phone (619) 221-6550

3853 Rosecrans St
San Diego, CA 92110
Phone (619) 615-0439

4647 Zion Ave
San Diego, CA 92120
Phone (619) 528-3038

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1246320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634342400000",
    "number": "1053549998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3420 KENYON ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921105001",
            "telephone_number": "877-496-0450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3420 KENYON ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921105001",
            "telephone_number": "877-496-0450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARVEEN",
        "first_name": "SHAHIDA",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-30",
        "last_updated": "2021-10-16",
        "certification_date": "2021-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "CA",
            "license": "A106558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4647 Zion Ave",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921202507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SHAHIDA",
            "last_name": "KHAN",
            "prefix": "DR.",
            "credential": "M.D",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.