Individual provider Active NPI

Shazmin Gangji, PA-C

  • Physician Assistant
  • Escondido, CA
National Provider Identifier
1346763638
Registry record updated Jan 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA58443 Issued in CA
Practice address
460 N Elm St
Escondido, CA 92025-3002
Phone
(760) 520-8100
NPI assigned
Jul 19, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 021063 NY
Physician Assistant 363A00000X PA58443 CA Primary

Addresses

Primary practice location

460 N Elm St
Escondido, CA 92025-3002

Mailing address

460 N Elm St
Escondido, CA 92025-3002
Phone (760) 520-8100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ, CA3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20170914001822 NY Practitioner - Physician Assistant 7517231533 Reassigns benefits to 2 organizations
I20210723000860 NJ Practitioner - Physician Assistant 7517231533
I20230221001754 CA Practitioner - Physician Assistant 7517231533 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Neighborhood HealthcareGroup PAC ID 5294649406, 153 clinicians

Practice addresses (Care Compare)

460 N Elm St
Escondido, CA 92025-3002
Phone (760) 520-8100

855 E Madison Ave
El Cajon, CA 92020-3819
Phone (619) 440-2751

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
021063NYMDClinical Child & Adolescent Psychologist
58443CAMDAmbulatory Care Pharmacist
PA58443CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Neighborhood Healthcare CurrentSince Feb 1, 2023 Accepting new patients
Physicians of University Hospital, PC CurrentSince Aug 28, 2017 Accepting new patients
Neighborhood Healthcare CurrentSince Feb 1, 2023 Accepting new patients

Locations

855 E Madison Ave
El Cajon, CA 92020
Phone (619) 440-2751

425 N Date St
#0
Escondido, CA 92025

460 N Elm St
Escondido, CA 92025
Phone (760) 520-8100

425 N Date St
Escondido, CA 92025
Phone (760) 737-2035

475 Seaview Ave
Staten Island, NY 10305
Phone (718) 226-8855

1 Edgewater St
Fl 6
Staten Island, NY 10305
Phone (718) 226-1047

242 Mason Ave
Staten Island, NY 10305
Phone (718) 226-1458

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: sgangji830663@direct.ochin.org

Organizations & group practices 4

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": "1500422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674172800000",
    "number": "1346763638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "460 N ELM ST",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920253002",
            "telephone_number": "760-520-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 N ELM ST",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920253002",
            "telephone_number": "760-520-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANGJI",
        "first_name": "SHAZMIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-19",
        "last_updated": "2023-01-20",
        "certification_date": "2023-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "021063",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA58443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Escondido, CA

Sources for this page

Verify at the official NPI Registry.