NPIMap

Individual provider Active NPI

Jay M Shenaq, MD

  • Plastic Surgery Physician
  • Sugar Land, TX
National Provider Identifier
1255421483
Registry record updated Dec 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
J5674 Issued in TX
Practice address
1111 Highway 6 Ste 10
Sugar Land, TX 77478-4917
Phone
(832) 532-7100
Fax
(832) 532-7410
NPI assigned
Oct 16, 2006
Last updated
Dec 29, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X C52028 CA
Plastic Surgery Physician 208200000X J5674 TX Primary

Addresses

Primary practice location

1111 Highway 6 Ste 10
Sugar Land, TX 77478-4917

Mailing address

16605 Southwest Fwy
Ste 510
Sugar Land, TX 77479
Phone (832) 532-7100

Other identifiers 2

IdentifierTypeStateIssuer
53AVOtherBCBS TX
030565801MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101203000964 TX Practitioner - Plastic and Reconstructive Surgery 0648467548 Reassigns benefits to 1 organization
Practice locations: Sugar Land, TX

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Baylor College of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1111 Hwy 6
Suite 10
Sugar Land, CO 77478-4914

16605 Southwest Fwy
Suite 510
Sugar Land, TX 77479-3473
Phone (832) 532-7100

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy16

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C52028CAMDPlastic Surgery Physician
J5674TXMDPlastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Houston Institute of Plastic Surgery, PLLC Plastic Surgery PastSince Jan 2, 2022 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: jshenaq@direct.uspi.com

Organizations & group practices 2

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

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": "1640736000000",
    "number": "1255421483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16605 SOUTHWEST FWY",
            "address_2": "STE 510",
            "city": "SUGAR LAND",
            "state": "TX",
            "postal_code": "77479",
            "telephone_number": "832-532-7100",
            "fax_number": "832-532-7410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 HIGHWAY 6 STE 10",
            "city": "SUGAR LAND",
            "state": "TX",
            "postal_code": "774784917",
            "telephone_number": "832-532-7100",
            "fax_number": "832-532-7410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHENAQ",
        "first_name": "JAY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2021-12-29",
        "certification_date": "2021-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "CA",
            "license": "C52028",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "TX",
            "license": "J5674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS TX",
            "identifier": "53AV",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "030565801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sugar Land, TX

Sources for this page

Verify at the official NPI Registry.