Patrick Kelly Shanovich, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

NONE Issued in CA

Practice address

1401 S Grand Ave
Emergency Department
Los Angeles, CA 90015-3010

Phone

(213) 742-5555

NPI assigned

Jul 19, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• County of Los Angeles

  • General Acute Care Hospital
  • Torrance, CA
  • NPI 1851363188
  Medicare reassignment NPD
• Golden State Emergency Physicians Inc

  • Emergency Medicine Physician
  • Los Angeles, CA
  • NPI 1770886558
  Medicare reassignment NPD
• Victory Emergency Physicians Medical Group Inc

  • Emergency Medicine Physician
  • Los Angeles, CA
  • NPI 1932402716
  Medicare reassignment NPD
• County of Los Angeles

  • Clinic/Center
  • Los Angeles, CA
  • NPI 1295407401
  NPD

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

{
    "created_epoch": "1184803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391472000000",
    "number": "1487854469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 S GRAND AVE",
            "address_2": "EMERGENCY DEPARTMENT",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900153010",
            "telephone_number": "213-742-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 S GRAND AVE",
            "address_2": "EMERGENCY DEPARTMENT",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900153010",
            "telephone_number": "213-742-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANOVICH",
        "first_name": "PATRICK",
        "middle_name": "KELLY",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-19",
        "last_updated": "2014-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "NONE",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Makaila Shannon
• Mary Vivianne Shannon, DDS
• Tara Rose Shannon
• Taylor Leslie Shannon, MD
• Venita Shannonhouse
• Garo Shant
• Shanthimd Dermatology, Inc.
• Chengqun Shao, M.D
• Ling Shao, M.D.,PH.D.
• Mingyue Shao

• Emergency Medicine Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2014; 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.