Individual provider Active NPI

Shawn M Baisley, PA-C

  • Physician Assistant
  • San Diego, CA
National Provider Identifier
1376936120
Registry record updated Oct 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
52347 Issued in CA
Practice address
3544 30TH St
San Diego, CA 92104-4120
Phone
(619) 515-2424
NPI assigned
Mar 17, 2015
Last updated
Oct 17, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 52347 CA Primary

Addresses

Primary practice location

3544 30TH St
San Diego, CA 92104-4120

Mailing address

823 Gateway Center Way
San Diego, CA 92102-4541
Phone (619) 515-2300

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150519002532 CA Practitioner - Physician Assistant 3072833813 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1809 National Ave
San Diego, CA 92113-2113
Phone (619) 515-2300

3514 30TH St
San Diego, CA 92104-4120
Phone (619) 515-2424

3544 30TH St
San Diego, CA 92104-4120
Phone (619) 515-2424

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
52347CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Centers of San Diego Inc Current Accepting new patients
Family Health Centers of San Diego Inc CurrentSince Jun 6, 2025 Accepting new patients
Patient First Richmond Medical Group PLLC Past Accepting new patients

Locations

1000 Euclid Ave
National City, CA 91950
Phone (619) 267-8100

3544 30th St
San Diego, CA 92104
Phone (619) 515-2424

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1426550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665964800000",
    "number": "1376936120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 GATEWAY CENTER WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921024541",
            "telephone_number": "619-515-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3544 30TH ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921044120",
            "telephone_number": "619-515-2424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAISLEY",
        "first_name": "SHAWN",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-17",
        "last_updated": "2022-10-17",
        "certification_date": "2022-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "52347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.