Blake Robert Shaw, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

G61394 Issued in CA

Practice address

1809 National Ave
San Diego, CA 92113-2113

Phone

(619) 515-2300

NPI assigned

Jun 23, 2006

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Ophthalmology

Education

University of California, Davis School of Medicine, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Family Health Centers of San Diego IncGroup PAC ID 3476446378, 299 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Family Health Centers of San Diego, Inc

  dba Logan Heights Family Health Center

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1447281936
  Medicare reassignment Care Compare group NPD
• Family Health Centers of San Diego, Inc

  dba Escondido Physical Health and Wellness

  • Federally Qualified Health Center (FQHC)
  • Escondido, CA
  • NPI 1356178180
  NPD
• Braswell's Leisure Manor

  • Assisted Living Facility
  • Yucaipa, CA
  • NPI 1609153402
  NPD (past)
• California Wound Healing Medical Group Inc.

  • Surgical Physician Assistant
  • Alhambra, CA
  • NPI 1235333972
  NPD (past)
• Eastlake Laser Eye Associates

  • Ocularist
  • Chula Vista, CA
  • NPI 1629152814
  NPD (past)
• Miravilla SNF Healthcare, LLC

  dba Oak Glen Post Acute

  • Skilled Nursing Facility
  • Cherry Valley, CA
  • NPI 1043908221

  Ophthalmology

  NPD (past)
• Qarmon PC

  dba California Foot and Ankle Clinic

  • Foot & Ankle Surgery Podiatrist
  • Riverside, CA
  • NPI 1376935163
  NPD (past)

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1649206541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4793 VALDINA WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921242437",
            "telephone_number": "858-576-1956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1809 NATIONAL AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921132113",
            "telephone_number": "619-515-2300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "890 Eastlake Parkway, Ste. #205",
            "address_purpose": "LOCATION",
            "city": "Chula Vista",
            "state": "CA",
            "postal_code": "91914",
            "country_code": "US",
            "telephone_number": "619-216-0400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4725 Market St",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921024715",
            "country_code": "US",
            "telephone_number": "619-515-2560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAW",
        "first_name": "BLAKE",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "G61394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandra Shaw, LAC
• Andrea Shaw
• Angela Holmes Shaw
• Ashley Shaw, FNP-C
• Ashley America Shaw
• Brittany Shaw
• Brittney Kayla Shaw, DMD
• Daniel Woodson Shaw, M.D.
• David Joseph Shaw, M.D.
• David Michael Shaw, MD

• Ophthalmology Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Ophthalmology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.