Individual provider Active NPI

Cynthia H Sholly, MD

  • Pediatrics Physician
  • Orange, CA
National Provider Identifier
1255411401
Registry record updated Jan 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
000000G57317 Issued in CA
Practice address
Uci Medical Center
101 The City Drive South
Orange, CA 92868
Phone
(714) 456-8978
NPI assigned
Oct 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 000000G57317 CA Primary

Addresses

Primary practice location

Uci Medical Center
101 The City Drive South
Orange, CA 92868

Mailing address

PO Box 54559
Uci Department of Pediatrics
Los Angeles, CA 90054-0559
Phone (714) 456-6369

Other practice location 1

2212 E 4th St
Santa Ana, CA 92705-3870
Phone (714) 571-7700

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
I20090116000051 CA Practitioner - Pediatric Medicine 6406919414 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
000000G57317CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of California Irvine CurrentSince Nov 15, 2014 Accepting new patients
UC Regents Uci Dept of Pediatrics Pediatrics CurrentSince Jan 1, 2008 Accepting new patients
University of California Irvine CurrentSince Nov 15, 2014 Accepting new patients

Locations

300 W Carl Karcher Way
Anaheim, CA 92801
Phone (657) 282-6356

101 The City Dr S
Orange, CA 92868
Phone (714) 456-6054

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547510400000",
    "number": "1255411401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 54559",
            "address_2": "UCI DEPARTMENT OF PEDIATRICS",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900540559",
            "telephone_number": "714-456-6369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "UCI MEDICAL CENTER",
            "address_2": "101 THE CITY DRIVE SOUTH",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "92868",
            "telephone_number": "714-456-8978"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2212 E 4th St",
            "address_purpose": "LOCATION",
            "city": "Santa Ana",
            "state": "CA",
            "postal_code": "927053870",
            "country_code": "US",
            "telephone_number": "714-571-7700",
            "fax_number": "714-571-7705",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHOLLY",
        "first_name": "CYNTHIA",
        "middle_name": "H",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-16",
        "last_updated": "2019-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "000000G57317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.