Mark Shaffer, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

C42649 Issued in CA

Practice address

7877 Parkway Dr
Suite1B
La Mesa, CA 91942-2000

Phone

(619) 461-3717

Fax

(619) 461-5663

NPI assigned

Sep 14, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Advantage Health Systems

  • Community Based Hospice Care Agency
  • San Diego, CA
  • NPI 1235414343

  Contracted Managing Employee

  CMS ownership

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.

• Centro de Salud de la Comunidad de San Ysidro, Inc.

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1124782685
  Medicare reassignment NPD
• Centro de Salud de la Comunidad de San Ysidro, Inc.

  • Federally Qualified Health Center (FQHC)
  • Chula Vista, CA
  • NPI 1326486861
  NPD
• City of Hope Medical Group of Illinois PLLC

  • Specialist
  • Zion, IL
  • NPI 1548258072
  NPD (past)

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283385600000",
    "number": "1255436804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7877 PARKWAY DR",
            "address_2": "SUITE1B",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919422000",
            "telephone_number": "619-461-3717",
            "fax_number": "619-461-5663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7877 PARKWAY DR",
            "address_2": "SUITE1B",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919422000",
            "telephone_number": "619-461-3717",
            "fax_number": "619-461-5663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFFER",
        "first_name": "MARK",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2010-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "C42649",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Erin Smith Shaffer, CMT
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• Neema Shakibai, M.D.

• Internal Medicine Physician in La Mesa, CA
• Providers in La Mesa, 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 Sep 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.