NPIMap

Organization Active NPI

High Desert Nephrology Medical Associates, Inc.

  • Nephrology Physician
  • Victorville, CA
National Provider Identifier
1407865652
Registry record updated Sep 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
HIGH DESERT NEPHROLOGY MEDICAL ASSOCIATES, INC.
Practice address
12675 Hesperia Rd
Victorville, CA 92395-5878
Phone
(760) 241-3306
Fax
(760) 241-5037
NPI assigned
Aug 5, 2006
Last updated
Sep 8, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2010

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

Authorized official

Name
Jay Eriah Shankar, MDNPI 1164431318
Title
Ceo
Phone
(760) 241-3306

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X NU Primary

Addresses

Primary practice location

12675 Hesperia Rd
Victorville, CA 92395-5878

Mailing address

12675 Hesperia Rd
Victorville, CA 92395-5878
Phone (760) 241-3306

Other identifiers 1

IdentifierTypeStateIssuer
1407865652MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050415000858 CA Part B Supplier - Clinic/Group Practice 2860439288 Receives reassigned benefits from 8 practitioners
Practice locations: Big Bear Lake, CA; Victorville, CA; Barstow, CA

National Provider Directory

National Provider Directory
Tax ID family
High Desert Nephrology Med3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

11883 Amethyst Rd
Ste 100
Victorville, CA 92392
Phone (661) 272-3777

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283904000000",
    "number": "1407865652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12675 HESPERIA RD",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955878",
            "telephone_number": "760-241-3306",
            "fax_number": "760-241-5037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12675 HESPERIA RD",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955878",
            "telephone_number": "760-241-3306",
            "fax_number": "760-241-5037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGH DESERT NEPHROLOGY MEDICAL ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2010-09-08",
        "status": "A",
        "authorized_official_last_name": "SHANKAR",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "ERIAH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "760-241-3306",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407865652",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Victorville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2010; 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.