Individual provider Active NPI

Shang Knesek

  • Family Nurse Practitioner
  • Fresno, CA
National Provider Identifier
1609415140
Registry record updated Dec 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
NP95014156 Issued in CA
Practice address
568 E Herndon Ave Ste 201
Fresno, CA 93720-2989
Phone
(559) 228-6600
NPI assigned
Jan 1, 2020
Last updated
Dec 6, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 6, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN11005524 FL
Family Nurse Practitioner 363LF0000X NP95014156 CA Primary

Addresses

Primary practice location

568 E Herndon Ave Ste 201
Fresno, CA 93720-2989

Mailing address

568 E Herndon Ave Ste 201
Fresno, CA 93720-2989
Phone (415) 533-8838

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221021002178 CA Practitioner - Nurse Practitioner 7911373568 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Nephrology Group IncGroup PAC ID 4688767262, 50 clinicians

Practice addresses (Care Compare)

568 E Herndon Ave
Suite 104
Fresno, CA 93720-2989
Phone (559) 228-6600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP95014156CAMDFamily Nurse Practitioner
APRN11005524FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Nephrology Group, Inc. Nephrology CurrentSince Nov 1, 2022 Accepting new patients
The Nephrology Group, Inc. Clinical Lab CurrentSince Nov 1, 2022 Accepting new patients

Locations

568 E Herndon Ave
Ste 104
Fresno, CA 93720

568 E Herndon Ave
Ste 201
Fresno, CA 93720
Phone (559) 228-9660

900 N Douty St
#B
Hanford, CA 93230
Phone (559) 325-7775

233 E Caldwell Ave
Visalia, CA 93277
Phone (559) 475-0431

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1577836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670284800000",
    "number": "1609415140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "568 E HERNDON AVE STE 201",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937202989",
            "telephone_number": "415-533-8838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "568 E HERNDON AVE STE 201",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937202989",
            "telephone_number": "559-228-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNESEK",
        "first_name": "SHANG",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-01",
        "last_updated": "2022-12-06",
        "certification_date": "2022-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11005524",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP95014156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.