Shada Abubaker
Individual provider Active NPI Nurse Practitioner · Long Beach, CA
NPI 1891419552 · NPPES record last updated Sep 27, 2022
Key facts
- NPI
- 1891419552
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 95022127 (CA)
- Practice address
- 1250 N Bellflower Blvd
Long Beach, CA 90840-0004 - Phone
- (562) 985-4463
- NPI assigned
- Sep 27, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Hoag Clinic
Practice addresses (Care Compare)
1 Hoag Dr
BLDG 41
Newport Beach, CA 92663-4162
Phone (949) 764-4060
Hospital & facility affiliations
- Hoag Memorial Hospital Presbyterian
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241115001376 | CA | Practitioner - Nurse Practitioner | 6709310550 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95022127 | CA | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hoag Clinic | Current |
Accepting new patients |
Locations
1 Hoag Dr
Bldg 41
Newport Beach, CA 92663
Phone (949) 764-4060
1 Hoag Dr
Newport Beach, CA 92663
Phone (877) 742-4624
1031 Avenida Pico
Ste 204
San Clemente, CA 92673
Phone (949) 829-5533
Interoperability endpoints
- https://api.platform.athenahealth.com/10944/brand/3/csg/1/fhir/r4
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 95022127 | CA | Yes |
Addresses
Primary practice location
1250 N Bellflower Blvd
Long Beach, CA 90840-0004
Mailing address
1250 N Bellflower Blvd
Long Beach, CA 90840-0004
Other providers in Long Beach, CA
- Khadejah Abraham
- Gary Morris Abrahams
- Ashlee Abram
- Esmeralda Abril
- Noel Pangilinan Abril
- Sherlyn Abundis
- Jocelyn Sacapano Abutin
- Deena Abuyounes
- Kathleen Acab
- Access Imaging, LLC
All providers in Long Beach, CA · Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 27, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.