Individual provider Active NPI

Mahnaz Shambayati, PA-C

  • Physician Assistant
  • Costa Mesa, CA
National Provider Identifier
1639574395
Registry record updated Jun 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA67676 Issued in CA
Practice address
1650 Adams Ave
Costa Mesa, CA 92626-4958
Phone
(949) 270-2100
Fax
(949) 650-4458
NPI assigned
Oct 23, 2014
Last updated
Jun 22, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA67676 CA Primary
Medical Physician Assistant 363AM0700X PA67676 CA

Addresses

Primary practice location

1650 Adams Ave
Costa Mesa, CA 92626-4958

Mailing address

20151 SW Birch St Ste 100
Newport Beach, CA 92660-1794
Phone (949) 270-2100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20210401000302 TX Practitioner - Physician Assistant 6204243611 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Healthcare Services IncGroup PAC ID 2163339722, 3,431 clinicians

Practice addresses (Care Compare)

800 College Pkwy
Lewisville, TX 75077-3503
Phone (972) 420-8543

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA09470TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Catalyst Physician Group - NTX, PLLC CurrentSince Sep 6, 2025 Accepting new patients

Locations

1610 Commons Cir
Northlake, TX 76226
Phone (940) 725-3400

8080 Independence Pkwy
Ste 200
Plano, TX 75025
Phone (972) 596-9511

Interoperability endpoints

  • Direct secure messaging: mahnaz.shambayati.1@30724.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1414022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782086400000",
    "number": "1639574395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20151 SW BIRCH ST STE 100",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926601794",
            "telephone_number": "949-270-2100",
            "fax_number": "949-650-4458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 ADAMS AVE",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926264958",
            "telephone_number": "949-270-2100",
            "fax_number": "949-650-4458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAMBAYATI",
        "first_name": "MAHNAZ",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-23",
        "last_updated": "2026-06-22",
        "certification_date": "2026-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA67676",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA67676",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Costa Mesa, CA

Sources for this page

Verify at the official NPI Registry.