Shenoda Yousef Azmy Abd Elmaseh
Individual provider Active NPI Family Medicine Physician · Mission Viejo, CA
NPI 1194348656 · NPPES record last updated Nov 9, 2023
Key facts
- NPI
- 1194348656
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 181983 (CA)
- Practice address
- 26800 Crown Valley Pkwy Ste 150
Mission Viejo, CA 92691-8018 - Phone
- (949) 276-2111
- NPI assigned
- May 19, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Providence Medical Foundation
Exer Medical Corporation
Practice addresses (Care Compare)
100 E Valencia Mesa Dr
Suite 105
Fullerton, CA 92835-3816
Phone (714) 871-3006
1950 Sunny Crest Dr
Suite 2900
Fullerton, CA 92835-3641
Phone (714) 992-5350
2100 S Euclid St
Suite 102
Anaheim, CA 92802-4572
Phone (714) 644-9100
235 E 17TH St
Costa Mesa, CA 92627-3831
Phone (949) 688-2010
26777 Agoura Rd
Suite B4
Calabasas, CA 91302-2967
Phone (818) 880-2225
26800 Crown Valley Pkwy
Mission Viejo, CA 92691-6384
4143 Campus Dr
Suite C200
Irvine, CA 92612-2693
Phone (949) 471-0002
5101 Lakewood Blvd
Lakewood, CA 90712-2413
Phone (562) 800-3883
831 S State College Blvd
Anaheim, CA 92806-4613
Phone (714) 533-2273
Hospital & facility affiliations
- Providence Mission Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231122000958 | CA | Practitioner - Family Practice | 7012365547 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 181983 | CA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Providence Medical Foundation | Family Medicine | Current |
Accepting new patients |
| Providence Medical Foundation | Current | Accepting new patients | |
| Providence Medical Foundation | Family Medicine | Past | Accepting new patients |
| Good Shepherd Medical Center | Family Medicine | Past | Accepting new patients |
Locations
200 W Ctr St Promenade
Ste 300
Anaheim, CA 92805
Phone (714) 449-4841
2700 Dolbeer St
Eureka, CA 95501
Phone (707) 269-4229
100 E Valencia Mesa Dr
Ste 105
Fullerton, CA 92835
Phone (714) 446-5200
1950 Sunny Crest Dr
Ste 2900
Fullerton, CA 92835
26800 Crown Valley Pkwy
Ste 150
Mission Viejo, CA 92691
Phone (949) 276-2111
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 181983 | CA | Yes |
Addresses
Primary practice location
26800 Crown Valley Pkwy Ste 150
Mission Viejo, CA 92691-8018
Mailing address
6472 Warner Ave Apt E
Huntington Beach, CA 92647-5158
Phone (714) 487-1151
Other practice location 1
2700 Dolbeer St
Eureka, CA 95501-4736
Phone (707) 445-8121
Other providers in Mission Viejo, CA
- A Serene Senior Living LLC
- Azar Abadi
- Valeria Abarca
- Abbi Care Inc
- Skylar Mason Abbott
- Iman Abdeshahian
- Azhar Abdullah
- Brittany Abelson
- Abiding Home Care LLC
- Ahmad Abou Abbass
All providers in Mission Viejo, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 9, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.