Jie Shi Yan, M.D.

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

A78071 Issued in CA

Practice address

2925 Sycamore Dr
Suite 160
Simi Valley, CA 93065-1207

Phone

(805) 584-0177

Fax

(805) 584-1179

NPI assigned

Jul 19, 2005

Last updated

Jul 18, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

Specialty

NephrologyAlso: Internal Medicine

Education

Stanford University School of Medicine, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

California Kidney Medical Group IncGroup PAC ID 2769396357, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• DaVita Simi Valley Dialysis Dialysis facility, Simi Valley, CA, CCN 052638
• DaVita Moorpark Dialysis Center Dialysis facility, Moorpark, CA, CCN 552728
• SRS-Thousand Oaks Dialysis Dialysis facility, Thousand Oaks, CA, CCN 052873
• Adventist Health Simi Valley Hospital, Simi Valley, CA, CCN 050236
• Los Robles Hospital & Medical Center Hospital, Thousand Oaks, CA, CCN 050549
• Northridge Hospital Medical Center Hospital, Northridge, CA, CCN 050116

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: jieshi.yan@ventura.cernerdirect.com

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.

• California Kidney Medical Group, Inc

  • Nephrology Physician
  • Moorpark, CA
  • NPI 1760586705
  Medicare reassignment Care Compare group NPD
• County of Ventura

  dba Ventura County Medical Center

  • General Acute Care Hospital
  • Ventura, CA
  • NPI 1629167457
  Medicare reassignment NPD
• Jonathan Nasseri MD Corp

  dba United Inpatient Consultants

  • Internal Medicine Physician
  • Simi Valley, CA
  • NPI 1194063529
  Medicare reassignment NPD
• West Coast Renal Medical Group, Inc

  • Nephrology Physician
  • Simi Valley, CA
  • NPI 1740637875
  NPD Authorized official
• California Kidney Medical Group Inc

  • Clinical Medical Laboratory
  • Simi Valley, CA
  • NPI 1649291774
  NPD
• County of Ventura

  dba VCBH - Simi Valley Youth & Family Mental Health

  • Community/Behavioral Health Agency
  • Simi Valley, CA
  • NPI 1609098243
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• SRS-Thousand Oaks

  dba SRS-Thousand Oaks, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Thousand Oaks, CA
  • NPI 1912654468

  Dialysis facility

  Care Compare affiliation Name & address match
• Total Renal Care Inc

  dba Simi Valley Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Simi Valley, CA
  • NPI 1467781179

  Dialysis facility

  Care Compare affiliation Name & address match
• Dignity Community Care

  dba Northridge Hospital Medical Center

  • General Acute Care Hospital
  • Northridge, CA
  • NPI 1417089350
  Care Compare affiliation
• Los Robles Regional Medical Center

  dba Los Robles Hospital & Medical Center

  • General Acute Care Hospital
  • Thousand Oaks, CA
  • NPI 1306890389
  Care Compare affiliation
• Simi Valley Hospital and Health Care Services

  • General Acute Care Hospital
  • Simi Valley, CA
  • NPI 1063495190
  Care Compare affiliation

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689638400000",
    "number": "1396744546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2160",
            "city": "MOORPARK",
            "state": "CA",
            "postal_code": "930202160",
            "telephone_number": "818-718-2301",
            "fax_number": "818-718-2311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2925 SYCAMORE DR",
            "address_2": "SUITE 160",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930651207",
            "telephone_number": "805-584-0177",
            "fax_number": "805-584-1179"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1227 E Los Angeles Ave",
            "address_purpose": "LOCATION",
            "city": "Simi Valley",
            "state": "CA",
            "postal_code": "930652871",
            "country_code": "US",
            "telephone_number": "805-582-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YAN",
        "first_name": "JIE SHI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-19",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A78071",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jieshi.yan@ventura.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Cerner Direct Secure Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Information",
            "address_1": "1227 E Los Angeles Ave",
            "city": "Simi Valley",
            "state": "CA",
            "country_code": "US",
            "postal_code": "930652871",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Nephrology Physician in Simi Valley, CA
• Providers in Simi Valley, CA by specialty
• Nephrology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.