Active NPI
Clarence L Shields Jr., M.D.
- Sports Medicine (Orthopaedic Surgery) Physician
- Los Angeles, CA
National Provider Identifier
1245201938
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Orthopaedic Surgery) Physician
- License
- C29184
- Practice address
- 6801 Park Ter
Los Angeles, CA 90045-1543 - Phone
- (310) 665-7228
- Fax
- (310) 641-3978
- NPI assigned
- Jan 30, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | C29184 | CA | |
| Sports Medicine (Orthopaedic Surgery) Physician | 207XX0005X | C29184 | CA | Primary |
Addresses
Primary practice location
6801 Park Ter
Los Angeles, CA 90045-1543
Mailing address
6801 Park Ter
Los Angeles, CA 90045-1543
Phone (310) 665-7228
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 1, 2015 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C29184 | CA | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cedars-Sinai Medical Care Foundation | Specialist | Past | Accepting new patients |
Interoperability endpoints
- cshields212124@direct.cshs.org
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 and National Provider Directory roles.
-
- Specialist
- Los Angeles, CA
- NPI 1316984388
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630022400000",
"number": "1245201938",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6801 PARK TER",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900451543",
"telephone_number": "310-665-7228",
"fax_number": "310-641-3978"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6801 PARK TER",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900451543",
"telephone_number": "310-665-7228",
"fax_number": "310-641-3978"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIELDS",
"first_name": "CLARENCE",
"middle_name": "L",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-30",
"last_updated": "2021-08-27",
"certification_date": "2021-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "C29184",
"primary": false
},
{
"code": "207XX0005X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery, Sports Medicine",
"state": "CA",
"license": "C29184",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2021; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.