Individual provider Active NPI

Amin Sharif, PA-C

  • Medical Physician Assistant
  • Laguna Hills, CA
National Provider Identifier
1174022818
Registry record updated Sep 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA61600 Issued in CA
Practice address
27001 Moulton Pkwy Ste A102
Laguna Hills, CA 92656-3626
Phone
(949) 600-1907
NPI assigned
Feb 8, 2018
Reactivated
Sep 16, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X
Medical Physician Assistant 363AM0700X PA61600 CA Primary

Addresses

Primary practice location

27001 Moulton Pkwy Ste A102
Laguna Hills, CA 92656-3626

Mailing address

27001 Moulton Pkwy Ste A102
Laguna Hills, CA 92656-3626

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221111001984 CA Practitioner - Physician Assistant 1254708779 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
61600CAMDGeneral Practice Dentistry
PA61600CAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - Neurology PC CurrentSince Mar 1, 2023 Accepting new patients
Cep America - Neurology PC CurrentSince Mar 1, 2023 Accepting new patients
Nellie Gail Urgent Care PastSince Sep 25, 2022 Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

31700 Temecula Pkwy
Temecula, CA 92592
Phone (951) 303-8939

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.

NPI Registry JSON

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

{
    "created_epoch": "1518048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663718400000",
    "number": "1174022818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27001 MOULTON PKWY STE A102",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926563626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27001 MOULTON PKWY STE A102",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926563626",
            "telephone_number": "949-600-1907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHARIF",
        "first_name": "AMIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-08",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-16",
        "deactivation_date": "2022-08-25",
        "reactivation_date": "2022-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA61600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laguna Hills, CA

Sources for this page

Verify at the official NPI Registry.