Amy Wall Shore, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

30993 Issued in AL

Practice address

4553 Glencoe Ave Ste 100
Marina del Rey, CA 90292-7917

Phone

(949) 988-7800

NPI assigned

May 6, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 9

Other names 1

• Amy Suzanne Wall Former name

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

Specialty

Anesthesiology

Education

Louisiana State University School of Medicine in Shreveport, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bright Anesthesia a Professional CorporationGroup PAC ID 4183114028, 14 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Bright Anesthesia a Professional Corporation

  • Anesthesiology Physician
  • Los Angeles, CA
  • NPI 1518858356
  Medicare reassignment Care Compare group NPD
• Shore MDS Medical Corp

  • Anesthesiology Physician
  • Los Angeles, CA
  • NPI 1427491018
  Medicare reassignment NPD Authorized official
• Westside Anesthesia Services

  • Anesthesiology Physician
  • Manhattan Beach, CA
  • NPI 1528381704
  Medicare reassignment NPD
• Nickul S. Jain MD, a Professional Corporation

  • Orthopaedic Surgery Physician
  • Newport Beach, CA
  • NPI 1194469346
  NPD
• Lunada Anesthesia Services

  • Anesthesiology Physician
  • Manhattan Beach, CA
  • NPI 1851167910
  NPD (past)
• Shore Orthopedics a Professional Corporation

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Marina del Rey, CA
  • NPI 1376312074
  NPD (past)
• Trias Global, LLC

  • Orthopaedic Surgery of the Spine Physician
  • Newport Beach, CA
  • NPI 1518433457
  NPD (past)

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

{
    "created_epoch": "1210032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763164800000",
    "number": "1235305566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1590 ROSECRANS AVE STE D",
            "city": "MANHATTAN BEACH",
            "state": "CA",
            "postal_code": "902663716",
            "telephone_number": "310-737-2844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4553 GLENCOE AVE STE 100",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902927917",
            "telephone_number": "949-988-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORE",
        "first_name": "AMY",
        "middle_name": "WALL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-06",
        "last_updated": "2025-11-15",
        "certification_date": "2025-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MA",
            "license": "226228",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AL",
            "license": "30993",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A123437",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "132224",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "132231",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "051120731",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "132222",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "051120732",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "051120734",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "051120729",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "132226",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01600227",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "WALL",
            "middle_name": "SUZANNE",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Loraine Sue Shimada, R.D.
• Steven Shimoyama, M.D.
• Phoebe Park Shinn, PMHNP-BC
• Shore Hip and Joint
• Shore Orthopedics a Professional Corporation
• Brett I. Shore, MD
• Elinaz Shoushtari Moghaddam, D.D.S.
• John Sico, PT, DPT
• Farhad Sigari, MD
• Simon Grock DDS Apc

• Anesthesiology Physician in Marina del Rey, CA
• Providers in Marina del Rey, CA by specialty
• Anesthesiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.