Alfred C Shen Medical Corporation

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

A52041 Issued in CA

Legal business name

ALFRED C SHEN MEDICAL CORPORATION

Practice address

72780 Country Club Dr Ste A104
Rancho Mirage, CA 92270-4150

Phone

(760) 895-0639

Fax

(760) 423-6339

NPI assigned

Nov 1, 2006

Last updated

Jun 28, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alfred C Shen, M.D.NPI 1598879595

Title

President

Phone

(760) 895-0639

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Alfred C. Shen, M.D.

  • Neurological Surgery Physician
  • Rancho Mirage, CA
  • NPI 1598879595
  Medicare reassignment Authorized official
• Farhad M Limonadi, MD

  • Neurological Surgery Physician
  • Rancho Mirage, CA
  • NPI 1154386399
  NPD (past)
• Shahin Etebar, MD

  • Neurological Surgery Physician
  • Columbus, GA
  • NPI 1194721308
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1730266990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 217",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922700217",
            "telephone_number": "760-895-0639",
            "fax_number": "760-423-6339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72780 COUNTRY CLUB DR STE A104",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922704150",
            "telephone_number": "760-895-0639",
            "fax_number": "760-423-6339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALFRED C SHEN MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A",
        "authorized_official_last_name": "SHEN",
        "authorized_official_first_name": "ALFRED",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "760-895-0639",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "CA",
            "license": "A52041",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "00A520411",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA MEDICAL LICENSE",
            "identifier": "A52041",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Neurological Surgery Physician in Rancho Mirage, CA
• Providers in Rancho Mirage, CA by specialty
• Neurological Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.