Abdul Shukoor Enayat, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

C150664 Issued in CA

Practice address

12550 Hesperia Rd Ste 100
Victorville, CA 92395-5873

Phone

(760) 241-6666

Fax

(760) 947-5619

NPI assigned

Jun 10, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TN

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

Medicare enrollment (NPD)

Enrolled

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.

• State of Tennessee

  • Public Health or Welfare Agency
  • Jasper, TN
  • NPI 1487791315
  Medicare reassignment NPD
• State of Tennessee

  • Public Health or Welfare Agency
  • Springfield, TN
  • NPI 1316090145
  NPD
• State of Tennessee State F&a Payroll

  • Psychiatric Hospital
  • Nashville, TN
  • NPI 1194869297
  NPD

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1255372181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W CENTER STREET PROMENADE STE 400",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928053960",
            "telephone_number": "714-449-4800",
            "fax_number": "714-449-4956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12550 HESPERIA RD STE 100",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955873",
            "telephone_number": "760-241-6666",
            "fax_number": "760-947-5619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENAYAT",
        "first_name": "ABDUL",
        "middle_name": "SHUKOOR",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-10",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "MC16944",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "C150664",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN",
            "identifier": "P00614804",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "44D0984814",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cyndee J Elwood, MFT
• Dorien Emanuel, PSYD
• Emil Zakhary DDS Inc
• Empire Medical Center
• Empire Prosthetic & Orthotic Center
• Nigar Enayat, M.D.
• Lisa Marie Engelhardt, PA
• Jakelyn Maria Enriquez
• Amethyst Entsuah
• Equal Education for All

• Internal Medicine Physician in Victorville, CA
• Providers in Victorville, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.