NPIMap

Individual provider Active NPI

Anil Vallabhdas Shah, M.D.

  • Specialist
  • Santa Ana, CA
National Provider Identifier
1619997368
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A35578 Issued in CA
Practice address
2621 S Bristol St
#108
Santa Ana, CA 92704-5718
Phone
(714) 754-1684
Fax
(714) 966-0417
NPI assigned
Jul 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X A35578 CA Primary

Addresses

Primary practice location

2621 S Bristol St
#108
Santa Ana, CA 92704-5718

Mailing address

2621 S Bristol St
#108
Santa Ana, CA 92704-5718
Phone (714) 754-1684

Other identifiers 2

IdentifierTypeStateIssuer
OOA355780MedicaidCA
A35578OtherCASTATE MEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120127000741 CA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 3577545409 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
University of California, Geffen School of Medicine, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Coastal Heart IncGroup PAC ID 6709868623, 2 clinicians

Practice addresses (Care Compare)

2621 S Bristol St
Suite 108
Santa Ana, CA 92704-5718
Phone (714) 754-1684

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting1-10
Varicose vein removal63
Leg revascularization (restoring blood flow)44

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Chino Vascular & Surgery Center Inc CurrentSince Oct 11, 2019 Accepting new patients
Cardiovascular Interventional Surgery Center Current Accepting new patients
Coastal Heart, Inc CurrentSince May 15, 2001 Accepting new patients
Coast Medical Professionals Alliance, Ipa Current Accepting new patients
South Coast Global Medical Center, Inc Past Accepting new patients
Anaheim Global Medical Center, Inc PastSince Jan 1, 2005 Accepting new patients
Hoag Memorial Hospital Presbyterian Past Accepting new patients
Orange County Global Medical Center, Inc Past Accepting new patients
Memorial Medical Group Inc Past Accepting new patients

Locations

11760 Central Ave
Ste 204
Chino, CA 91710
Phone (909) 632-1225

2621 S Bristol St
Ste 108
Santa Ana, CA 92704
Phone (714) 241-9070

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: anil.shah.d1.p1@direct.cscla.nextgenshare.com

Organizations & group practices 9

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 2

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": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1619997368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2621 S BRISTOL ST",
            "address_2": "#108",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927045718",
            "telephone_number": "714-754-1684",
            "fax_number": "714-966-0417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2621 S BRISTOL ST",
            "address_2": "#108",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927045718",
            "telephone_number": "714-754-1684",
            "fax_number": "714-966-0417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "ANIL",
        "middle_name": "VALLABHDAS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A35578",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OOA355780",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "A35578",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Ana, CA

Sources for this page

Verify at the official NPI Registry.