Individual provider Active NPI

Pooja Shah Menon, M.D.

  • Family Medicine Physician
  • Chula Vista, CA
National Provider Identifier
1053600064
Registry record updated Aug 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A123263 Issued in CA
Practice address
678 3Rd Ave
Chula Vista, CA 91910-5736
Phone
(619) 662-4100
NPI assigned
Mar 30, 2011
Last updated
Aug 26, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036139740 IL
Family Medicine Physician 207Q00000X A123263 CA Primary

Addresses

Primary practice location

678 3Rd Ave
Chula Vista, CA 91910-5736

Mailing address

1601 Precision Park LN
San Diego, CA 92173-1345
Phone (619) 205-6349

Other names 1

  • Pooja Shah Former name

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
I20140908002146 CA Practitioner - Family Practice 1557586559 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
New York Medical College, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1136 D Ave
National City, CA 91950-3412
Phone (619) 662-4100

1637 3Rd Ave
Suite B
Chula Vista, CA 91911-5823
Phone (619) 662-4100

4004 Beyer Blvd
San Ysidro, CA 92173-2007
Phone (619) 428-4463

4050 Beyer Blvd
San Ysidro, CA 92173-2007
Phone (619) 662-4100

678 3Rd Ave
Chula Vista, CA 91910-5736
Phone (619) 662-4100

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A123263CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centro de Salud de la Comunidad de San Ysidro, Inc. Current Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. CurrentSince Sep 13, 2019 Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. Past Accepting new patients
Sharp Memorial Hospital Past Accepting new patients
Grossmont Hospital Corporation Past Accepting new patients
Sharp Chula Vista Medical Center Past Accepting new patients
Rady Children's Hospital San Diego Past Accepting new patients

Locations

1637 Third Ave
Ste B
Chula Vista, CA 91911
Phone (619) 425-1780

678 Third Ave
Chula Vista, CA 91910
Phone (619) 205-6349

1136 D Ave
National City, CA 91950
Phone (619) 336-2300

1601 Precision Park Ln
San Ysidro, CA 92173
Phone (619) 205-4585

Organizations & group practices 7

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

NPI Registry JSON

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

{
    "created_epoch": "1301443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566777600000",
    "number": "1053600064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 PRECISION PARK LN",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921731345",
            "telephone_number": "619-205-6349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "678 3RD AVE",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919105736",
            "telephone_number": "619-662-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENON",
        "first_name": "POOJA",
        "middle_name": "SHAH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-30",
        "last_updated": "2019-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036139740",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A123263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "POOJA",
            "last_name": "SHAH",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Chula Vista, CA

Sources for this page

Verify at the official NPI Registry.