NPIMap

Organization Active NPI

Pacific Shores Medical Group, Inc

  • Hematology & Oncology Physician
  • Irvine, CA
National Provider Identifier
1447587050
Registry record updated Aug 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
Legal business name
PACIFIC SHORES MEDICAL GROUP, INC
Practice address
16300 Sand Canyon Ave
Ste 207
Irvine, CA 92618
Phone
(949) 333-7580
Fax
(949) 333-7599
NPI assigned
Nov 3, 2009
Last updated
Aug 22, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2018

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

Authorized official

Name
Nerses Simon Tchekmedyain, MD
Title
Ceo
Phone
(949) 333-7580

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RH0003X Primary

Addresses

Primary practice location

16300 Sand Canyon Ave
Ste 207
Irvine, CA 92618

Mailing address

1043 Elm Ave
Ste 104
Long Beach, CA 90813-3271
Phone (562) 590-0345

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040417000523 CA Part B Supplier - Clinic/Group Practice 0749275808 Receives reassigned benefits from 30 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Irvine, CA; Torrance, CA; Newport Beach, CA; Long Beach, CA; Huntington Beach, CA; Glendale, CA

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1500 S Central Ave
Ste 210
Glendale, CA 91204
Phone (818) 500-0999

19670 Beach Blvd
#315
Huntington Beach, CA 92648

19670 Beach Blvd
Ste 315
Huntington Beach, CA 92648

1000 Fivepoint
Ste A
Irvine, CA 92618
Phone (888) 333-4673

3747 Worsham Ave
Ste 101
Long Beach, CA 90808
Phone (562) 430-5900

1300 N Vermont Ave
Ste 805
Los Angeles, CA 90027
Phone (323) 953-2956

Practitioners & affiliated clinicians

Practitioners 12

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": "1257206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534896000000",
    "number": "1447587050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1043 ELM AVE",
            "address_2": "STE 104",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908133271",
            "telephone_number": "562-590-0345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16300 SAND CANYON AVE",
            "address_2": "STE 207",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "92618",
            "telephone_number": "949-333-7580",
            "fax_number": "949-333-7599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC SHORES MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-03",
        "last_updated": "2018-08-22",
        "status": "A",
        "authorized_official_last_name": "TCHEKMEDYAIN",
        "authorized_official_first_name": "NERSES",
        "authorized_official_middle_name": "SIMON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-333-7580",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Irvine, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2018; 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.