Individual provider Active NPI

Babak Robert Shahrestani, DC

  • Chiropractor
  • Costa Mesa, CA
National Provider Identifier
1619018850
Registry record updated Dec 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
19600 Issued in CA
Practice address
2328 Newport Blvd
Costa Mesa, CA 92627-1548
Phone
(949) 631-3139
Fax
(949) 631-0747
NPI assigned
Feb 9, 2007
Last updated
Dec 20, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 19600 CA Primary
Sports Physician Chiropractor 111NS0005X DC19600 CA

Addresses

Primary practice location

2328 Newport Blvd
Costa Mesa, CA 92627-1548

Mailing address

2328 Newport Blvd
Costa Mesa, CA 92627-1548
Phone (949) 631-3139

Other identifiers 2

IdentifierTypeStateIssuer
33-0793733OtherCACORPORATE NUMBER
33-0479857OtherCAOLD CORPORATE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100427000407 CA Practitioner - Chiropractic 8022145861 Practice locations: Costa Mesa, CA

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Los Angeles College of Chiropractic, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2328 Newport Blvd
Costa Mesa, CA 92627-1548
Phone (949) 631-3139

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DC19600CAMDSports Physician Chiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Shahrestani Chiropractic Professional Corporation PastSince Jan 27, 2010 Accepting new patients

Organizations & group practices 1

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": "1170979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482192000000",
    "number": "1619018850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2328 NEWPORT BLVD",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926271548",
            "telephone_number": "949-631-3139",
            "fax_number": "949-631-0747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2328 NEWPORT BLVD",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926271548",
            "telephone_number": "949-631-3139",
            "fax_number": "949-631-0747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAHRESTANI",
        "first_name": "BABAK",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-09",
        "last_updated": "2016-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "19600",
            "primary": true
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "CA",
            "license": "DC19600",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORPORATE NUMBER",
            "identifier": "33-0793733",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OLD CORPORATE NUMBER",
            "identifier": "33-0479857",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Costa Mesa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.