Individual provider Active NPI

Scott Shiffman, MD

  • Family Medicine Physician
  • Rancho Santa Margarita, CA
National Provider Identifier
1164413514
Registry record updated Jun 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A45794 Issued in CA
Practice address
29472 Avenida de Las Bandera
Rancho Santa Margarita, CA 92688-2651
Phone
(949) 459-9968
Fax
(949) 766-2565
NPI assigned
Nov 3, 2005
Last updated
Jun 21, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2011

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 A45794 CA Primary

Addresses

Primary practice location

29472 Avenida de Las Bandera
Rancho Santa Margarita, CA 92688-2651

Mailing address

2742 Dow Ave
Tustin, CA 92780-7242
Phone (714) 665-1600

Other identifiers 1

IdentifierTypeStateIssuer
00A457940MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Bristol Park Medical Group, Inc Family Medicine Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: scott.shiffman.d1.p7@direct.monarchhealthcare.nextgenshare.com

Organizations & group practices 1

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": "1130976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308614400000",
    "number": "1164413514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2742 DOW AVE",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927807242",
            "telephone_number": "714-665-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29472 AVENIDA DE LAS BANDERA",
            "city": "RANCHO SANTA MARGARITA",
            "state": "CA",
            "postal_code": "926882651",
            "telephone_number": "949-459-9968",
            "fax_number": "949-766-2565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIFFMAN",
        "first_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-03",
        "last_updated": "2011-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A45794",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A457940",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Santa Margarita, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.