Shore Orthopedics a Professional Corporation

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

Legal business name

SHORE ORTHOPEDICS A PROFESSIONAL CORPORATION

Practice address

4551 Glencoe Ave Ste 145
Marina del Rey, CA 90292-6385

Phone

(949) 988-7800

NPI assigned

Dec 22, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Brett Shore, MDNPI 1578699989

Title

Owner

Phone

(617) 686-7177

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 2

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

• Brett I. Shore, MD

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Marina del Rey, CA
  • NPI 1578699989
  Medicare reassignment NPD Authorized official
• Amy Wall Shore, M.D.

  • Anesthesiology Physician
  • Marina del Rey, CA
  • NPI 1235305566
  NPD (past)

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

{
    "created_epoch": "1703203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710806400000",
    "number": "1376312074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2009 FAYMONT AVE",
            "city": "MANHATTAN BEACH",
            "state": "CA",
            "postal_code": "902664150",
            "telephone_number": "617-686-7177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4551 GLENCOE AVE STE 145",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926385",
            "telephone_number": "949-988-7800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3501 Jamboree Rd Ste 1250",
            "address_purpose": "LOCATION",
            "city": "Newport Beach",
            "state": "CA",
            "postal_code": "926602959",
            "country_code": "US",
            "telephone_number": "949-988-7800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SHORE ORTHOPEDICS A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-22",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A",
        "authorized_official_last_name": "SHORE",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-686-7177",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grant Daniel Shifflett, M.D.
• Loraine Sue Shimada, R.D.
• Steven Shimoyama, M.D.
• Phoebe Park Shinn, PMHNP-BC
• Shore Hip and Joint
• Amy Wall Shore, M.D.
• Brett I. Shore, MD
• Elinaz Shoushtari Moghaddam, D.D.S.
• John Sico, PT, DPT
• Farhad Sigari, MD

• Sports Medicine (Orthopaedic Surgery) Physician in Marina del Rey, CA
• Providers in Marina del Rey, CA by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; 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.