NPIMap

Organization Active NPI

High Desert Nephrology Medical Associates, Inc.

  • Nephrology Physician
  • Barstow, CA
National Provider Identifier
1508196759
Registry record updated Feb 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
HIGH DESERT NEPHROLOGY MEDICAL ASSOCIATES, INC.
Practice address
655 S. 7TH Ave.
Barstow, CA 92311-3001
Phone
(760) 256-3918
Fax
(760) 256-5217
NPI assigned
Jan 12, 2010
Organization subpart
Yes
Parent organization
HIGH DESERT NEPHROLOGY MEDICAL ASSOCIATES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 23, 2011

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

Authorized official

Name
Jay Eriah Shankar, M.D.NPI 1164431318
Title
Owner/Medical Director
Phone
(760) 241-3306

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X CA Primary

Addresses

Primary practice location

655 S. 7TH Ave.
Barstow, CA 92311-3001

Mailing address

12675 Hesperia Rd.
Victorville, CA 92395-5878
Phone (760) 241-3306

Other identifiers 1

IdentifierTypeStateIssuer
1508196759MedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
High Desert Nephrology Med3 organizations share this tax ID, including this one
Part of
High Desert Nephrology Med

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1263254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298419200000",
    "number": "1508196759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12675 HESPERIA RD.",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955878",
            "telephone_number": "760-241-3306",
            "fax_number": "760-241-8063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 S. 7TH AVE.",
            "city": "BARSTOW",
            "state": "CA",
            "postal_code": "923113001",
            "telephone_number": "760-256-3918",
            "fax_number": "760-256-5217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGH DESERT NEPHROLOGY MEDICAL ASSOCIATES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HIGH DESERT NEPHROLOGY MEDICAL ASSOCIATES, INC.",
        "enumeration_date": "2010-01-12",
        "last_updated": "2011-02-23",
        "status": "A",
        "authorized_official_last_name": "SHANKAR",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "ERIAH",
        "authorized_official_title_or_position": "OWNER/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "760-241-3306",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1508196759",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Barstow, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.