Individual provider Active NPI

Shaheen I Idries, MD

  • Pediatric Infectious Diseases Physician
  • Orange, CA
National Provider Identifier
1194812263
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Infectious Diseases PhysicianTaxonomy code 2080P0208X
License
A50795 Issued in CA
Practice address
455 S Main St
Orange, CA 92868-3835
Phone
(714) 532-7601
Fax
(714) 532-7650
NPI assigned
Oct 9, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Infectious Diseases Physician 2080P0208X A50795 CA Primary

Addresses

Primary practice location

455 S Main St
Orange, CA 92868-3835

Mailing address

455 S Main St
Orange, CA 92868-3835
Phone (714) 289-4511

Other identifiers 1

IdentifierTypeStateIssuer
A50795MedicaidCA

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
I20151030001549 CA Practitioner - Pediatric MedicinePractitioner - Gastroenterology 7517277767 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Gastroenterology
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1201 W la Veta Ave
Orange, CA 92868-4203
Phone (888) 770-2462

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A50795CAMDPediatric Infectious Diseases Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children's Hospital of Orange County Pediatric Infectious Diseases CurrentSince Oct 13, 2018 Accepting new patients

Locations

500 Superior Ave
Ste 140
Newport Beach, CA 92663
Phone (949) 631-3603

1201 W La Veta Ave
Orange, CA 92868
Phone (714) 509-8481

455 S Main St
Orange, CA 92868
Phone (714) 289-4511

Dept LA 21333
Pasadena, CA 91185

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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": "1160352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194812263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 S MAIN ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683835",
            "telephone_number": "714-289-4511",
            "fax_number": "714-289-4788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 S MAIN ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683835",
            "telephone_number": "714-532-7601",
            "fax_number": "714-532-7650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDRIES",
        "first_name": "SHAHEEN",
        "middle_name": "I",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0208X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Infectious Diseases",
            "state": "CA",
            "license": "A50795",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A50795",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.