Philip S Shore M D Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G071824 Issued in CA

Legal business name

PHILIP S SHORE M D INC

Doing business as

Shore to Shore Medical Group

Practice address

18546 Roscoe Blvd
Suite 302
Northridge, CA 91324-4663

Phone

(818) 886-1100

Fax

(818) 886-7501

NPI assigned

Jul 19, 2006

Last updated

Jun 22, 2015By the provider in NPPES

Organization subpart

Yes

Parent organization

PHILIP S. SHORE, M.D. INC.As reported in NPPES

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

Authorized official

Name

Philip S Shore, MDNPI 1295750529

Title

MD

Phone

(818) 886-1100

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• SHORE TO SHORE MEDICAL GROUP Doing business as

Part of

Philip S Shore M D Inc

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 1

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.

• Philip S Shore, MD

  • Family Medicine Physician
  • Northridge, CA
  • NPI 1295750529
  Authorized official Same address or phone

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434931200000",
    "number": "1568481315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18546 ROSCOE BLVD",
            "address_2": "SUITE 302",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913244663",
            "telephone_number": "818-886-1100",
            "fax_number": "818-886-7501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18546 ROSCOE BLVD",
            "address_2": "SUITE 302",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913244663",
            "telephone_number": "818-886-1100",
            "fax_number": "818-886-7501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILIP S SHORE M D INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHILIP S. SHORE, M.D. INC.",
        "enumeration_date": "2006-07-19",
        "last_updated": "2015-06-22",
        "status": "A",
        "authorized_official_last_name": "SHORE",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "818-886-1100",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G071824",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE  SHIELD",
            "identifier": "00G718240",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHORE TO SHORE MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hannah Peterson
• Andrew Ngoc-Minh Pham, PHARMD
• Tra Mi N Pham
• Evonne Hoa Phan
• Raymond Thanhle Phan, DO
• Beth Jo Phillips, PT, DPA
• Emily Phung
• Thu Phung, MSW, LCSW
• Jessica Pichardo, AMFT 146836
• Kevin J Pidgeon, MD

• Family Medicine Physician in Northridge, CA
• Providers in Northridge, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2015; 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.