NPIMap

Individual provider Active NPI

Bashar Mousa Shahatit, M.D.

  • Family Medicine Physician
  • Apple Valley, CA
National Provider Identifier
1831416742
Registry record updated Nov 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A122792 Issued in CA
Practice address
19341 Bear Valley Rd Ste 104
Apple Valley, CA 92308-5152
Phone
(760) 956-4148
NPI assigned
May 2, 2010
Last updated
Nov 10, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A122792 CA Primary

Addresses

Primary practice location

19341 Bear Valley Rd Ste 104
Apple Valley, CA 92308-5152

Mailing address

19341 Bear Valley Rd Ste 104
Apple Valley, CA 92308-5152

Other practice location 1

2450 Sister Mary Columba Dr
Red Bluff, CA 96080-4356
Phone (530) 527-0414

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bshahatit1373629@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131125001218 CA Practitioner - Family Practice 0042462731 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians
Carepath Medical Group IncGroup PAC ID 8224499868, 9 clinicians

Practice addresses (Care Compare)

12550 Hesperia Rd
Suite 100
Victorville, CA 92395-5873
Phone (760) 241-6666

401 N Brand Blvd
Glendale, CA 91203-4427
Phone (818) 301-9754

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A122792CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation CurrentSince Jul 5, 2016 Accepting new patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation Family Medicine CurrentSince Jul 5, 2016 Accepting new patients
Dignity Health Past Accepting new patients
Catholic Healthcare West Past Accepting new patients
Providence Medical Foundation Family Medicine Past Accepting new patients

Locations

200 W Ctr St Promenade
Ste 400
Anaheim, CA 92805

19333 Bear Valley Rd
Ste 101
Apple Valley, CA 92308
Phone (760) 240-3784

19333 Bear Valley Rd
Ste 106
Apple Valley, CA 92308
Phone (760) 240-5505

19341 Bear Valley Rd
Ste 104
Apple Valley, CA 92308
Phone (760) 956-4148

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842

12550 Hesperia Rd
Ste 100
Victorville, CA 92395

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: bshahatit1373629@oc.providencedirect.org

Organizations & group practices 7

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 9

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": "1272758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636502400000",
    "number": "1831416742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19341 BEAR VALLEY RD STE 104",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923085152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19341 BEAR VALLEY RD STE 104",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923085152",
            "telephone_number": "760-956-4148"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2450 Sister Mary Columba Dr",
            "address_purpose": "LOCATION",
            "city": "Red Bluff",
            "state": "CA",
            "postal_code": "960804356",
            "country_code": "US",
            "telephone_number": "530-527-0414",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAHATIT",
        "first_name": "BASHAR",
        "middle_name": "MOUSA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-02",
        "last_updated": "2021-11-10",
        "certification_date": "2021-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A122792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bshahatit1373629@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "19333 Bear Valley Rd Ste 101",
            "city": "Apple Valley",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923085149",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Apple Valley, CA

Sources for this page

Verify at the official NPI Registry.