Individual provider Active NPI

Annica M Shumny, PA-C

  • Physician Assistant
  • Santa Monica, CA
National Provider Identifier
1821474958
Registry record updated Mar 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA61459 Issued in CA
Practice address
1245 16TH St Ste 125
Santa Monica, CA 90404-1240
Phone
(310) 315-8900
Fax
(310) 315-8902
NPI assigned
Jul 30, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 30, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 164005771 IL
Physician Assistant 363A00000X 085006632 IL
Physician Assistant 363A00000X PA61459 CA Primary

Addresses

Primary practice location

1245 16TH St Ste 125
Santa Monica, CA 90404-1240

Mailing address

5767 W Century Blvd Ste 400
Los Angeles, CA 90045-5631
Phone (310) 301-8707

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, CA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20181102001832 IL Practitioner - Physician Assistant 2668781196 Reassigns benefits to 1 organization
I20230210000623 CA Practitioner - Physician Assistant 2668781196 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Regents of the University of CaliforniaGroup PAC ID 1355248584, 1,426 clinicians

Practice addresses (Care Compare)

100 Moody CT
Suite 200
Thousand Oaks, CA 91360-6082
Phone (805) 418-3500

1245 16TH St
Santa Monica, CA 90404-1240

19950 Rinaldi St
Porter Ranch, CA 91326-4141

2020 Santa Monica Blvd
Suite 210
Santa Monica, CA 90404-2139
Phone (310) 458-2381

6633 Telephone Rd
Ventura, CA 93003-5569

862 Aerovista PL
Suite 100
San Luis Obispo, CA 93401-8758
Phone (805) 549-8023

Hospital & facility affiliations

  • Santa Monica - UCLA Med Ctr & Orthopaedic Hospital Hospital, Santa Monica, CA, CCN 050112

Merit-based Incentive Payment System (MIPS)

Final score
87.51 of 100Reported as group
Quality
79.37
Promoting interoperability
100
Improvement activities
40
Cost
73.65

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
164005771ILMDRegistered Dietitian
PA61459CAMDPhysician Assistant
085006632ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Access Community Health Network CurrentSince Oct 8, 2018 Accepting new patients
Access Community Health Network CurrentSince Oct 8, 2018 Accepting new patients
The Regents of the University of California CurrentSince Apr 1, 2023 Accepting new patients
The Regents of the University of California CurrentSince Apr 1, 2023 Accepting new patients
UCLA Medical Group Past Accepting new patients

Locations

24302 Paseo de Valencia
Ste 200
Laguna Hills, CA 92653
Phone (949) 458-8252

5767 W Century Blvd
Ste 400
Los Angeles, CA 90045
Phone (310) 301-5200

File 55737
Los Angeles, CA 90074

1245 16th St
Ste 125
Santa Monica, CA 90404
Phone (310) 315-8900

2020 Santa Monica Blvd
Ste 210
Santa Monica, CA 90404
Phone (310) 458-2381

100 Moody Ct
Ste 200
Thousand Oaks, CA 91360
Phone (805) 418-3500

600 W Fulton St
Ste 200
Chicago, IL 60661
Phone (312) 526-2000

8321 W North Ave
Melrose Park, IL 60160
Phone (708) 681-2298

Interoperability endpoints

  • Direct secure messaging: ashumny1158277@direct.uclahealth.org

Organizations & group practices 6

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 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": "1438214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680134400000",
    "number": "1821474958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455631",
            "telephone_number": "310-301-8707",
            "fax_number": "310-301-8751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 16TH ST STE 125",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904041240",
            "telephone_number": "310-315-8900",
            "fax_number": "310-315-8902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUMNY",
        "first_name": "ANNICA",
        "middle_name": "M",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-30",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164005771",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085006632",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA61459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

Verify at the official NPI Registry.