NPIMap

Organization Active NPI

William R. Shankle MD Inc.

  • Neurology Physician
  • Newport Beach, CA
National Provider Identifier
1265078786
Registry record updated Aug 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
WILLIAM R. SHANKLE MD INC.
Practice address
3900 W Coast Hwy Ste 310
Newport Beach, CA 92663
Phone
(949) 478-8858
Fax
(949) 242-2465
NPI assigned
Nov 19, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2021

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

Authorized official

Name
Georgette Youssef
Title
Operations Manager
Phone
(949) 478-8858

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0400X Primary

Addresses

Primary practice location

3900 W Coast Hwy Ste 310
Newport Beach, CA 92663

Mailing address

3900 W Coast Hwy Ste 310
Newport Beach, CA 92663
Phone (949) 478-8858

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210426002722 CA Part B Supplier - Clinic/Group Practice 8921416280 Receives reassigned benefits from 2 practitioners
Practice locations: Newport Beach, CA

National Provider Directory

National Provider Directory

Locations

3900 W Coast Hwy
Ste 310
Newport Beach, CA 92663
Phone (949) 478-8858

369 San Miguel Dr
Ste 350
Newport Beach, CA 92660
Phone (949) 478-8858

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1574121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629417600000",
    "number": "1265078786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 W COAST HWY STE 310",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "92663",
            "telephone_number": "949-478-8858",
            "fax_number": "949-242-2465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 W COAST HWY STE 310",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "92663",
            "telephone_number": "949-478-8858",
            "fax_number": "949-242-2465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAM R. SHANKLE MD INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-19",
        "last_updated": "2021-08-20",
        "certification_date": "2021-08-20",
        "status": "A",
        "authorized_official_last_name": "YOUSSEF",
        "authorized_official_first_name": "GEORGETTE",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "949-478-8858"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.