Individual provider Active NPI

Seiji Bruce Shibata, M.D. PH.D.

  • Otolaryngology Physician
  • Los Angeles, CA
National Provider Identifier
1750674370
Registry record updated May 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
A168954 Issued in CA
Practice address
1450 San Pablo St Ste 5100
Los Angeles, CA 90033-5331
Phone
(323) 442-5790
NPI assigned
May 17, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X A168954 CA Primary

Addresses

Primary practice location

1450 San Pablo St Ste 5100
Los Angeles, CA 90033-5331

Mailing address

PO Box 31309
Los Angeles, CA 90031-0309
Phone (323) 442-5790

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address seiji.shibata@direct.usc.edu Direct USC CARE MEDICAL GROUP, INC

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20200622001376 CA Practitioner - Otolaryngology 1951540061 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Usc Care Medical Group IncGroup PAC ID 0446157747, 1,378 clinicians

Practice addresses (Care Compare)

1370 Foothill Blvd
Suite 100
La Canada, CA 91011-2100
Phone (818) 649-3919

1500 San Pablo St
Los Angeles, CA 90033-5313
Phone (323) 442-8444

1516 San Pablo St
Los Angeles, CA 90033-5313
Phone (800) 872-2273

1520 San Pablo St
Los Angeles, CA 90033-5310
Phone (800) 872-2273

1520 San Pablo St 1St Floor N
Los Angeles, CA 90033-5310
Phone (800) 872-2273

1812 Verdugo Blvd
Glendale, CA 91208-1407
Phone (818) 790-7100

222 W Eulalia St
Glendale, CA 91204-2851
Phone (818) 500-9999

300 W Hungtington Dr
Arcadia, CA 91007-3402
Phone (626) 898-8000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A168954CAMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Usc Care Medical Group, Inc Otolaryngology CurrentSince Jul 16, 2020 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Jul 16, 2020 Accepting new patients
Usc Verdugo Hills Hospital, LLC Past Accepting new patients
Usc University Hospital, Inc. Past Accepting new patients

Locations

125 W Huntington Dr
Ste A200
Arcadia, CA 91007

420 34th St
Bakersfield, CA 93301
Phone (661) 324-4647

9033 Wilshire Blvd
Ste 305
Beverly Hills, CA 90211
Phone (310) 278-0656

222 W Eulalia St
Ste 200
Glendale, CA 91204
Phone (818) 291-4010

1370 Foothill Blvd
Ste 100
La Canada Flt, CA 91011
Phone (818) 649-3919

1450 San Pablo St
Ste 5100
Los Angeles, CA 90033
Phone (323) 409-7316

1520 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-5849

1450 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-6335

Organizations & group practices 4

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 3

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": "1305590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652313600000",
    "number": "1750674370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31309",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900310309",
            "telephone_number": "323-442-5790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 SAN PABLO ST STE 5100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900335331",
            "telephone_number": "323-442-5790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIBATA",
        "first_name": "SEIJI",
        "middle_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "M.D. PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-17",
        "last_updated": "2022-05-12",
        "certification_date": "2022-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "A168954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "seiji.shibata@direct.usc.edu",
            "affiliation": "Y",
            "endpointDescription": "seiji.shibata@direct.usc.edu",
            "affiliationName": "USC CARE MEDICAL GROUP, INC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1450 San Pablo St Ste 5100",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900335331",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.