Individual provider Active NPI

Mashal A Shamel, MD

  • Emergency Medicine Physician
  • San Jose, CA
National Provider Identifier
1487875795
Registry record updated Dec 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
A97897 Issued in CA
Practice address
250 Hospital Pkwy
San Jose, CA 95119-1103
Phone
(408) 972-6175
NPI assigned
May 2, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X A97897 CA Primary

Addresses

Primary practice location

250 Hospital Pkwy
San Jose, CA 95119-1103

Mailing address

250 Hospital Pkwy
San Jose, CA 95119-1103
Phone (408) 972-6175

Other identifiers 1

IdentifierTypeStateIssuer
1487875795MedicaidCA

Other names 1

  • Mashal A Ahmadi Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071024000244 CA Practitioner - Emergency Medicine 3971690868 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Colorado School of Medicine, Denver, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern California Permanente Medical GroupGroup PAC ID 6002729175, shared by 4 NPIs, 11,250 clinicians

Practice addresses (Care Compare)

9961 Sierra Ave
Fontana, CA 92335-6720
Phone (909) 427-5000

Hospital & facility affiliations

  • Kaiser Foundation Hospital - San Diego Hospital, San Diego, CA, CCN 050515

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Jul 6, 2009 Accepting new patients
Southern California Permanente Medical Group CurrentSince Nov 18, 2012 Accepting new patients
Southern California Permanente Medical Group CurrentSince Jul 6, 2009 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Grossmont Emergency Medical Group Emergency Medicine Past Accepting new patients

Locations

9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910

4647 Zion Ave
San Diego, CA 92120
Phone (619) 528-3038

Organizations & group practices 6

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639094400000",
    "number": "1487875795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 HOSPITAL PKWY",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951191103",
            "telephone_number": "408-972-6175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 HOSPITAL PKWY",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951191103",
            "telephone_number": "408-972-6175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAMEL",
        "first_name": "MASHAL",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-02",
        "last_updated": "2021-12-10",
        "certification_date": "2021-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A97897",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1487875795",
            "state": "CA"
        }
    ],
    "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": "4647 Zion Ave",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921202507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MASHAL",
            "last_name": "AHMADI",
            "middle_name": "A",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.