Individual provider Active NPI

Peter Yi Shen, MD

  • Diagnostic Radiology Physician
  • Santa Cruz, CA
National Provider Identifier
1396900734
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
A110273 Issued in CA
Practice address
2025 Soquel Ave
Santa Cruz, CA 95062-1323
Phone
(831) 423-4111
NPI assigned
Jul 24, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X A110273 CA Primary

Addresses

Primary practice location

2025 Soquel Ave
Santa Cruz, CA 95062-1323

Mailing address

325 Distel Cir
Los Altos, CA 94022-1408

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE) The Permanente Medical Group

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110505000267 CA Practitioner - Diagnostic Radiology 8325223498 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
State University of New York Downstate Medical Center, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sutter Bay Medical FoundationGroup PAC ID 4284538778, 3,783 clinicians

Practice addresses (Care Compare)

16130 Juan Hernandez Dr
Morgan Hill, CA 95037-5527

2025 Soquel Ave
Santa Cruez, CA 95062-1323
Phone (831) 423-4111

2900 Chanticleer Ave
Santa Cruz, CA 95065-1816

2907 Chanticleer Ave
Santa Cruz, CA 95065-1815
Phone (831) 477-2375

2911 Chanticleer Ave
Santa Cruz, CA 95065-1815
Phone (831) 477-2350

2915 Chanticleer Ave
Santa Cruz, CA 95065-1815
Phone (831) 477-2375

4663 Scotts Valley Dr
Scotts Valley, CA 95066-4202
Phone (831) 458-6330

550 S Green Valley Rd
Watsonville, CA 95076-3053
Phone (831) 458-5865

7600 Old Dominion CT
Aptos, CA 95003-3821
Phone (831) 458-6200

795 El Camino Real
Palo Alto, CA 94301-2302
Phone (415) 600-1020

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
110273CAMDClinical Social Worker
A110273CAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Bay Medical Foundation CurrentSince Jun 24, 2024 Accepting new patients
Sutter Bay Medical Foundation Diagnostic Radiology CurrentSince Jun 24, 2024 Accepting new patients
Regents of the Univ of Ca CurrentSince Aug 22, 2018 Accepting new patients
Permanente Medical Group Inc Diagnostic Radiology Current Accepting new patients
Regents of the Univ of Ca Current Accepting new patients
Permanente Medical Group, Inc CurrentSince Sep 28, 2015 Accepting new patients
Sutter Bay Medical Foundation Current Accepting new patients
Regents of the Univ of Ca Diagnostic Radiology CurrentSince Aug 22, 2018 Accepting new patients
Permanente Medical Group Inc Diagnostic Radiology CurrentSince Sep 28, 2015 Accepting new patients

Locations (25 of 42)

18400 US Highway 18
Apple Valley, CA 92307
Phone (760) 810-7590

750 Auburn Ravine Rd
Auburn, CA 95603
Phone (530) 823-6131

3200 Bell Rd
Auburn, CA 95603
Phone (530) 886-7616

350 John Muir Pkwy
Ste 160
Brentwood, CA 94513
Phone (925) 204-1920

7551 Madison Ave
Citrus Hts, CA 95610
Phone (916) 904-3000

1950 University Ave
Ste 160
East Palo Alto, CA 94303
Phone (650) 317-8100

8110 Laguna Blvd
Elk Grove, CA 95758
Phone (916) 683-3955

3200 Kearney St
Fremont, CA 94538
Phone (510) 498-2800

1189 E Herndon Ave
Ste 103
Fresno, CA 93720
Phone (559) 450-7777

4753 W Shaw Ave
Ste 101
Fresno, CA 93722
Phone (559) 277-8738

900 N Douty St
Hanford, CA 93230
Phone (559) 587-9014

370 Distel Cir
Los Altos, CA 94022
Phone (650) 254-5200

325 Distel Cir
Los Altos, CA 94022
Phone (510) 204-3977

3850 G St
Merced, CA 95340
Phone (209) 384-6528

600 Coffee Rd
Modesto, CA 95355
Phone (209) 550-4755

101 Rowland Way
Ste 220
Novato, CA 94945
Phone (415) 878-7200

795 El Camino Real
#1112
Palo Alto, CA 94301

795 El Camino Real
Palo Alto, CA 94301
Phone (650) 324-1832

101 Monroe St
Petaluma, CA 94954
Phone (707) 763-4109

10850 White Rock Rd
Rancho Cordova, CA 95670

1555 East St
Ste 200
Redding, CA 96001
Phone (530) 229-0911

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

930 W Main St
Ripon, CA 95366
Phone (209) 599-4221

3201 Data Dr
Rncho Cordova, CA 95670
Phone (916) 851-1424

Interoperability endpoints

  • Direct secure messaging: pshen294480@hisp.ehr.sutterhealth.org

Organizations & group practices 9

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1216857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723766400000",
    "number": "1396900734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 DISTEL CIR",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940221408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2025 SOQUEL AVE",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950621323",
            "telephone_number": "831-423-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEN",
        "first_name": "PETER",
        "middle_name": "YI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-24",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A110273",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "700 Lawrence Expy",
            "city": "Santa Clara",
            "state": "CA",
            "country_code": "US",
            "postal_code": "950515173",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Santa Cruz, CA

Sources for this page

Verify at the official NPI Registry.