Elena Shostak, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

53310 Issued in CA

Practice address

14600 Sherman Way Ste 250
Van Nuys, CA 91405-2284

Phone

(818) 212-2223

Fax

(818) 212-2224

NPI assigned

Aug 18, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Mrs. Eleni Kreizidi Former name

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: elena.shostak.p1@direct.ccchcenter.nextgenshare.com

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.

• Complete Care Community Health Center, Inc

  • PACE Provider Organization
  • Los Angeles, CA
  • NPI 1215113964
  Medicare reassignment NPD
• Algos Inc., a Medical Corporation

  • Pain Medicine Physician
  • Pasadena, CA
  • NPI 1497747356
  Medicare reassignment
• Algos Inc., a Medical Corporation

  • Pain Medicine Physician
  • Visalia, CA
  • NPI 1245832419
  NPD
• Algos Inc., a Medical Corporation

  • Pain Medicine Physician
  • Reseda, CA
  • NPI 1780829952
  NPD
• Complete Care Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Visalia, CA
  • NPI 1316729403
  NPD

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

{
    "created_epoch": "1471478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472428800000",
    "number": "1831644020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6021 LINDLEY AVE UNIT 8",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913561726",
            "telephone_number": "323-788-8277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14600 SHERMAN WAY STE 250",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914052284",
            "telephone_number": "818-212-2223",
            "fax_number": "818-212-2224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOSTAK",
        "first_name": "ELENA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-18",
        "last_updated": "2016-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "53310",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "53310",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "53310",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELENI",
            "last_name": "KREIZIDI",
            "prefix": "MRS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Nicole Tawnya Shrieves, LPCC
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• Eliza Shubaralyan
• Jennifer Shullen, A.A., B.A, AOD CERT.

• Physician Assistant in Van Nuys, CA
• Providers in Van Nuys, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.