Shaokun Xu, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

25MA11069800 Issued in NJ

Practice address

622 W 168TH St
PH5-133
New York, NY 10032-3720

Phone

(212) 305-3226

Fax

(212) 305-3204

NPI assigned

Mar 30, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Vanessa Xu Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NJ, CA2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Allied Digestive Health, LLC

  • Gastroenterology Physician
  • West Long Beach, NJ
  • NPI 1265831259

  Single Specialty

  Medicare reassignment NPD
• Morris Avenue Endoscopy LLC

  • Anesthesiology Physician
  • Mountainside, NJ
  • NPI 1184778060

  Single Specialty

  Medicare reassignment NPD
• Northern Valley Anesthesiology, P.a.

  • Anesthesiology Physician
  • Englewood, NJ
  • NPI 1245289487

  Single Specialty

  Medicare reassignment NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Baldwin Park, CA
  • NPI 1770515280

  Single Specialty

  Medicare reassignment NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Santa Clarita, CA
  • NPI 1316409410
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Fullerton, CA
  • NPI 1336556059
  NPD
• Morris Avenue Endoscopy LLC

  • Ambulatory Surgical Clinic/Center
  • Mountainside, NJ
  • NPI 1780747394
  NPD (past)

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

{
    "created_epoch": "1490832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703203200000",
    "number": "1477085454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 ENGLE ST",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076311808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 W 168TH ST",
            "address_2": "PH5-133",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323720",
            "telephone_number": "212-305-3226",
            "fax_number": "212-305-3204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "XU",
        "first_name": "SHAOKUN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-30",
        "last_updated": "2023-12-22",
        "certification_date": "2021-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": "NJ",
            "license": "25MA11069800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "441 N Lakeview Ave",
            "city": "Anaheim",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928073028",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "VANESSA",
            "last_name": "XU",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Rebecca Xu
• Rebecca Liu Xu
• Rongxi Xu
• Ruimin Xu, NP
• Ruliang Xu, MD
• Sharon Xu
• Shiwei Xu
• Shuang Xu, DDS
• Susan S Xu, PHARMD
• Tao Xu

• Anesthesiology Physician in New York, NY
• Providers in New York, NY by specialty
• Anesthesiology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.