Active NPI
Kelsey Grace Shea
- Pediatrics Physician
- Los Angeles, CA
National Provider Identifier
1417585100
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 186311
- Practice address
- 1200 N State St Ird 112
Los Angeles, CA 90033 - Phone
- (323) 409-5707
- NPI assigned
- Mar 30, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 186311 | CA | Primary |
Addresses
Primary practice location
1200 N State St Ird 112
Los Angeles, CA 90033
Mailing address
2020 Zonal Ave RM 112
Los Angeles, CA 90089-0121
Phone (434) 305-6390
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240712002961 | CA | Order and Referring Only - Pediatric Medicine | 6507301694 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 186311 | CA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713830400000",
"number": "1417585100",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2020 ZONAL AVE RM 112",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900890121",
"telephone_number": "434-305-6390"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 N STATE ST IRD 112",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90033",
"telephone_number": "323-409-5707"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEA",
"first_name": "KELSEY",
"middle_name": "GRACE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-30",
"last_updated": "2024-04-23",
"certification_date": "2024-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "186311",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.